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General NPI Number Information
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NPI Number | 1205049699
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Entity Type | Individual
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Provider Name | BRIGID ALICE TRACEY G.N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 3525 BAYCHESTER AVE
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City | BRONX
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State | NY
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Zip | 10466-5001
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Country | US
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Telephone | 718-798-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 BAYCHESTER AVE
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City | BRONX
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State | NY
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Zip | 10466-5001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 3450439
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F340439
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License Number State | NY
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