Provider Demographics
NPI:1831177609
Name:TRACHTMAN, NEIL GEOFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:GEOFFREY
Last Name:TRACHTMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71 ROWLAND ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-288-3240
Mailing Address - Fax:518-288-3240
Practice Address - Street 1:61 ROWLAND ST
Practice Address - Street 2:SUITE 217
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-288-3240
Practice Address - Fax:518-288-3240
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143371208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00740496Medicaid
NY00740496Medicaid