Traci Conrad Mankuta, MAED

Primary specialty

SpecialistTaxonomy code 174400000X

License

842527 Issued in NY

Practice address

30 Woodlake Dr E
Woodbury, NY 11797-2317

Phone

(516) 802-2767

Fax

(516) 484-4150

NPI assigned

Jul 21, 2014

Last updated

Jul 21, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Traci Gabrielle Conrad Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1295142339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WOODLAKE DR E",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117972317",
            "telephone_number": "516-802-2767",
            "fax_number": "516-484-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WOODLAKE DR E",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117972317",
            "telephone_number": "516-802-2767",
            "fax_number": "516-484-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANKUTA",
        "first_name": "TRACI",
        "middle_name": "CONRAD",
        "name_prefix": "Prof.",
        "credential": "MAED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-21",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "842527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "CONRAD",
            "middle_name": "GABRIELLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deepika Malik
• Shari Beth Mallor, MSED
• Lawrence Joel Maltin, M.D.
• Marjorie S. Maltin, ED.D.
• Jill Mandel, MS CCC-SLP
• Lucian Miron Manu, M.D.
• Samantha Marinaro, NP
• Shabiah Colin Martin, M.D
• Marvin Boris MD and Stanley Weindorf MD (Lymphedema Therapy)
• Marvin Boris, M.D. PLLC (Lymphedema Therapy)

• Specialist in Woodbury, NY
• Providers in Woodbury, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.