Healthcare Provider Details

I. General information

NPI: 1811994775
Provider Name (Legal Business Name): TRACEY RANDALL AU.D.,F.A.A.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY CRESSWELL AU.D.,F.A.A.A

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 ROUTE 52
HOPEWELL JUNCTION NY
12533-3215
US

IV. Provider business mailing address

2623 ROUTE 52
HOPEWELL JUNCTION NY
12533-3215
US

V. Phone/Fax

Practice location:
  • Phone: 845-226-2638
  • Fax: 845-226-2674
Mailing address:
  • Phone: 845-226-2638
  • Fax: 845-226-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1494-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: