Provider Demographics
NPI:1962647958
Name:WOLINER, TRACEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:WOLINER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 E PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1915
Mailing Address - Country:US
Mailing Address - Phone:631-425-2145
Mailing Address - Fax:631-425-2296
Practice Address - Street 1:180 E PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-425-2121
Practice Address - Fax:631-425-2191
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant