MEDICARE: MS. TRACEY ROBERTS L.AC.

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	171100000X	Acupuncturist	005353	NY
2	171100000X	Acupuncturist	DA00431	RI

General Provider Information

NPI Number	:	1538565841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY ROBERTS L.AC.

Provider Business Mailing Address
First Line	:	123 WASHINGTON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-1518
Country	:	US
Telephone Number	:	917-538-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 WASHINGTON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-1518
Country	:	US
Telephone Number	:	917-538-2080
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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Directions to “ MS. TRACEY ROBERTS L.AC.” Practice Location

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