Provider Demographics
NPI:1356492839
Name:SPINNATO, TRACEY L (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:SPINNATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY STONY BROOK DEPARTMENT OF MEDICINE
Mailing Address - Street 2:101 NICOLLS ROAD HSC T16-020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-5160
Mailing Address - Country:US
Mailing Address - Phone:631-444-1665
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:205 N BELLE MEAD RD
Practice Address - Street 2:STONY BROOK PRIMARY CARE CENTER
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3483
Practice Address - Country:US
Practice Address - Phone:631-444-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208460207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH79989Medicare UPIN
NY62C311Medicare ID - Type Unspecified