Provider Demographics
NPI:1639524184
Name:RACITI, TINA N
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:N
Last Name:RACITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 YATES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2002
Mailing Address - Country:US
Mailing Address - Phone:917-612-0774
Mailing Address - Fax:
Practice Address - Street 1:1644 YATES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2002
Practice Address - Country:US
Practice Address - Phone:917-612-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1025758161174400000X
NY1029619161174400000X
NY1025604161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist