Provider Demographics
NPI:1528032521
Name:TRACZ, MICHAL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:J
Last Name:TRACZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-2400
Mailing Address - Fax:
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2220
Practice Address - Country:US
Practice Address - Phone:845-358-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252359-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03266002Medicaid
NY03266002Medicaid
MNP00055930Medicare ID - Type UnspecifiedRAILROAD