Tracy Melanie Gibson
Individual provider Active NPI Specialist · Brookyln, NY
NPI 1497019574 · NPPES record last updated Jun 3, 2013
Key facts
- NPI
- 1497019574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 485251101 (NY)
- Practice address
- 454 Nostrand Avenue
Brookyln, NY 11216 - Phone
- (917) 202-0171
- NPI assigned
- Jul 3, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 485251101 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Turner Services | Current | Accepting new patients | |
| Talking With Tracy | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 485251101 | NY | Yes |
Addresses
Primary practice location
454 Nostrand Avenue
Brookyln, NY 11216
Mailing address
454 Nostrand Avenue
Brookyln, NY 11216
Phone (917) 795-5824
Other providers in Brookyln, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.