MEDICARE: TRACY TOWERS MEDICAL P.C.

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	261Q00000X	Clinic/Center	203633	NY
2	261QM2500X	Medical Specialty Clinic/Center	203633	NY
3	261QP2300X	Primary Care Clinic/Center	203633	NY
4	302F00000X	Exclusive Provider Organization	203633	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518197052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACY TOWERS MEDICAL P.C.

Provider Business Mailing Address
First Line	:	1560 GRAND CONCOURSE
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10457-8402
Country	:	US
Telephone Number	:	718-733-6369
Fax Number	:	718-294-4365

Provider Business Practice Location Address
First Line	:	1560 GRAND CONCOURSE
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10457-8402
Country	:	US
Telephone Number	:	718-733-6369
Fax Number	:	718-294-4365

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAULA PATEL
Credential	:	M.D.
Telephone Number	:	71873363669

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	09/02/2010

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