Provider Demographics
NPI:1457681710
Name:TRACY, GREGORY T
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:TRACY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7838 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2743
Mailing Address - Country:US
Mailing Address - Phone:609-823-6460
Mailing Address - Fax:609-823-6494
Practice Address - Street 1:7838 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2743
Practice Address - Country:US
Practice Address - Phone:609-823-6460
Practice Address - Fax:609-823-6494
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ151 810 1484OtherORGANIZATIONAL NPI