Provider Demographics
NPI:1811393069
Name:POSDZICH, TRACY LEIGH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:POSDZICH
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 1:721 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3301
Mailing Address - Country:US
Mailing Address - Phone:518-687-1960
Mailing Address - Fax:518-687-1970
Practice Address - Street 1:721 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3301
Practice Address - Country:US
Practice Address - Phone:518-227-0453
Practice Address - Fax:518-309-6606
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22616357163W00000X
NY402039363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse