Healthcare Provider Details

I. General information

NPI: 1619170826
Provider Name (Legal Business Name): TRAM TRAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OLD COUNTRY RD STE 151
PLAINVIEW NY
11803-4942
US

IV. Provider business mailing address

875 OLD COUNTRY RD STE 151
PLAINVIEW NY
11803-4942
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-0202
  • Fax:
Mailing address:
  • Phone: 516-681-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011705
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011705
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier011705
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: