Provider Demographics
NPI:1437314259
Name:SIRC, TRACY A (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:SIRC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5815
Mailing Address - Country:US
Mailing Address - Phone:631-666-0901
Mailing Address - Fax:
Practice Address - Street 1:79 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5815
Practice Address - Country:US
Practice Address - Phone:631-666-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1099185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist