Provider Demographics
NPI:1518037753
Name:VINCEL, TRACEY LYNN (PT, MPHTY)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNN
Last Name:VINCEL
Suffix:
Gender:F
Credentials:PT, MPHTY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 22ND ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5142
Mailing Address - Country:US
Mailing Address - Phone:212-906-4440
Mailing Address - Fax:212-906-4420
Practice Address - Street 1:7 W 22ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5142
Practice Address - Country:US
Practice Address - Phone:212-906-4440
Practice Address - Fax:212-906-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019132-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23Y11Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER