Provider Demographics
NPI:1891929584
Name:AGNESE, TRACEY (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:AGNESE
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 1:390 WEST END AVE
Mailing Address - Street 2:PEDIATRIC AND ADOLESCENT MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6107
Mailing Address - Country:US
Mailing Address - Phone:212-787-1444
Mailing Address - Fax:212-799-8620
Practice Address - Street 1:390 W END AVE
Practice Address - Street 2:#1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6107
Practice Address - Country:US
Practice Address - Phone:212-263-7822
Practice Address - Fax:212-263-8172
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics