MEDICARE: MS. TRACY LEE CM, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	F000143	NY

General Provider Information

NPI Number	:	1013131838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY LEE CM, MS

Provider Business Mailing Address
First Line	:	168 CANAL ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10013-4503
Country	:	US
Telephone Number	:	212-431-5501
Fax Number	:	212-219-3601

Provider Business Practice Location Address
First Line	:	168 CANAL ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10013-4503
Country	:	US
Telephone Number	:	212-431-5501
Fax Number	:	212-219-3601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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