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1346249133 NPI number — TRACEY G TOBACK DPM

NPI Number: 1346249133
Health Care Provider/Practitioner: TRACEY G TOBACK DPM

Information about “1346249133” NPI (TRACEY G TOBACK DPM) exists in 1346249133 in HTML format HTML  |  1346249133 in plain Text format TXT  |  1346249133 in PDF (Portable Document Format) PDF  |  1346249133 in an XML format XML  formats.

NPI Number : 1346249133 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346249133",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TOBACK",
    "FirstName": "TRACEY",
    "MiddleName": "G",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "DPM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "43 GRAND ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KINGSTON",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12401-3933",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-339-3338",
    "MailingAddressFaxNumber": "845-340-1074",
    "FirstLinePracticeLocationAddress": "43 GRAND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KINGSTON",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12401-3933",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "845-339-3338",
    "PracticeLocationAddressFaxNumber": "845-340-1074",
    "EnumerationDate": "07/14/2005",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "N004154-3",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "000465",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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