Healthcare Provider Details

I. General information

NPI: 1336140433
Provider Name (Legal Business Name): JOHN PAUL TRACY NG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BROADWAY 1ST FLOOR
NEW YORK NY
10013-3699
US

IV. Provider business mailing address

408 BROADWAY 1ST FLOOR
NEW YORK NY
10013-3699
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8882
  • Fax: 212-925-8883
Mailing address:
  • Phone: 212-925-8882
  • Fax: 212-925-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number182321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: