Healthcare Provider Details

I. General information

NPI: 1295073617
Provider Name (Legal Business Name): TRACY SCHELLER, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 GRAND AVE SUITE 202
ENGLEWOOD NJ
07631-4154
US

IV. Provider business mailing address

370 GRAND AVE SUITE 202
ENGLEWOOD NJ
07631-4154
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-9599
  • Fax: 201-894-9192
Mailing address:
  • Phone: 201-894-9599
  • Fax: 201-894-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA72400
License Number StateNJ

VIII. Authorized Official

Name: VALERIE FORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-894-9599