Healthcare Provider Details

I. General information

NPI: 1245547546
Provider Name (Legal Business Name): MRS. TRACEY ROSE DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY ROSE MCDERMOTT MSPT

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E RIDGEWOOD AVE
PARAMUS NJ
07652-3629
US

IV. Provider business mailing address

1 E RIDGEWOOD AVE
PARAMUS NJ
07652-3629
US

V. Phone/Fax

Practice location:
  • Phone: 201-251-2422
  • Fax:
Mailing address:
  • Phone: 201-251-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA1240300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number018849
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: