Provider Demographics
NPI:1891057642
Name:MINER, TRACY (MS ED)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MACCARONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:21203 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21203 16TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1524
Practice Address - Country:US
Practice Address - Phone:516-238-3893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist