Provider Demographics
NPI:1679828792
Name:HOTEL TRADES
Entity Type:Organization
Organization Name:HOTEL TRADES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:COGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:646-335-3733
Mailing Address - Street 1:420 E 102ND ST
Mailing Address - Street 2:SUITE 2P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E 102ND ST
Practice Address - Street 2:SUITE 2P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5862
Practice Address - Country:US
Practice Address - Phone:646-335-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190754-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service