Healthcare Provider Details

I. General information

NPI: 1922629872
Provider Name (Legal Business Name): MATTHEW GREGORY TRACEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

145 CONCORD DR
RIVER EDGE NJ
07661-2118
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5000
  • Fax:
Mailing address:
  • Phone: 201-359-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA13119500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: