MEDICARE: TRACY L BREEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	212778	NY

General Provider Information

NPI Number	:	1396777413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY L BREEN MD

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PLACE
Second Line	:	BOX 3000 MOUNT SINAI DEPARTMENT OF MEDICINE
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-987-3100
Fax Number	:	212-731-5210

Provider Business Practice Location Address
First Line	:	5 EAST 98TH STREET
Second Line	:	BOX 1118 MOUNT SINAI HOSPITAL ENDOCRINOLOGY
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-241-7975
Fax Number	:	212-423-0508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/22/2010

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