Provider Demographics
NPI:1578505236
Name:ERNEY, TRACY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:ERNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2645
Mailing Address - Country:US
Mailing Address - Phone:518-622-8525
Mailing Address - Fax:518-622-9104
Practice Address - Street 1:4383 ROUTE 23
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2645
Practice Address - Country:US
Practice Address - Phone:518-622-8525
Practice Address - Fax:518-622-9104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429436Medicaid
NY5096D1Medicare ID - Type UnspecifiedEMPIRE
NY02429436Medicaid