Healthcare Provider Details

I. General information

NPI: 1821017617
Provider Name (Legal Business Name): GREGORY J TRACEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HUDSON ST STE 500
HOBOKEN NJ
07030-5642
US

IV. Provider business mailing address

241 PROSPECT AVE
ORADELL NJ
07649-2316
US

V. Phone/Fax

Practice location:
  • Phone: 201-653-7450
  • Fax:
Mailing address:
  • Phone: 201-966-4607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06653300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: