1710084512 NPI number — MRS. TRACY L MONACO PT

Table of content: MRS. TRACY L MONACO PT (NPI 1710084512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710084512 NPI number — MRS. TRACY L MONACO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONACO
Provider First Name:
TRACY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710084512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 1/2 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH BRIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08829-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-730-0591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08801-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-730-6640
Provider Business Practice Location Address Fax Number:
908-730-0468
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  QA04066 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com