Provider Demographics
NPI:1508962002
Name:ONAL, TRACY (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:ONAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2502
Mailing Address - Country:US
Mailing Address - Phone:631-581-0737
Mailing Address - Fax:631-581-0729
Practice Address - Street 1:45 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2502
Practice Address - Country:US
Practice Address - Phone:631-581-0737
Practice Address - Fax:631-581-0729
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204990204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG60752Medicare UPIN
NYO1V861Medicare ID - Type Unspecified