Provider Demographics
NPI:1932134632
Name:BARRY, TRACY L (DO)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 1ST AVE
Mailing Address - Street 2:APT 2808
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4326
Mailing Address - Country:US
Mailing Address - Phone:646-672-0789
Mailing Address - Fax:
Practice Address - Street 1:ST JOSEPH HOSPITAL
Practice Address - Street 2:127 S BROADWAY
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-378-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217281207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068904Medicaid
NY02068904Medicaid
NYH40305Medicare UPIN