NPI Code Detail JSON Logo

1295142339 NPI number — TRACI CONRAD MANKUTA MAED

NPI Number: 1295142339
Health Care Provider/Practitioner: TRACI CONRAD MANKUTA MAED

Information about “1295142339” NPI (TRACI CONRAD MANKUTA MAED) exists in 1295142339 in HTML format HTML  |  1295142339 in plain Text format TXT  |  1295142339 in PDF (Portable Document Format) PDF  |  1295142339 in an XML format XML  formats.

NPI Number : 1295142339 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295142339",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MANKUTA",
    "FirstName": "TRACI",
    "MiddleName": "CONRAD",
    "NamePrefix": "PROF.",
    "NameSuffix": null,
    "Credential": "MAED",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CONRAD",
    "OtherFirstName": "TRACI",
    "OtherMiddleName": "GABRIELLE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "30 WOODLAKE DR E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODBURY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11797-2317",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-802-2767",
    "MailingAddressFaxNumber": "516-484-4150",
    "FirstLinePracticeLocationAddress": "30 WOODLAKE DR E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBURY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11797-2317",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-802-2767",
    "PracticeLocationAddressFaxNumber": "516-484-4150",
    "EnumerationDate": "07/21/2014",
    "LastUpdateDate": "07/21/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "842527",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.