Provider Demographics
NPI:1295970697
Name:KOBELT-DANOSKY, TRACY LEE (NYSDISPENSER)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LEE
Last Name:KOBELT-DANOSKY
Suffix:
Gender:F
Credentials:NYSDISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2304
Mailing Address - Country:US
Mailing Address - Phone:845-735-3277
Mailing Address - Fax:845-735-8631
Practice Address - Street 1:6 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2304
Practice Address - Country:US
Practice Address - Phone:845-735-3277
Practice Address - Fax:845-735-8631
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000012293237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist