Healthcare Provider Details

I. General information

NPI: 1891076477
Provider Name (Legal Business Name): TRACY A MARCIANO MS, BA, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 CLINTON ST
WEST SENECA NY
14224-1501
US

IV. Provider business mailing address

3709 CLINTON ST
WEST SENECA NY
14224-1501
US

V. Phone/Fax

Practice location:
  • Phone: 646-642-1421
  • Fax:
Mailing address:
  • Phone: 646-642-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberCMT
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMEDICAL MASSAGE
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: