Active NPI
Tracy Quinn, SLP
- Speech-Language Pathologist
- East Moriches, NY
National Provider Identifier
1639688468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 012819-1
- Practice address
- 130 Montauk Hwy
East Moriches, NY 11940-1153 - Phone
- (631) 874-0571
- Fax
- (631) 745-2909
- NPI assigned
- Sep 25, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 012819-1 | NY | Primary |
Addresses
Primary practice location
130 Montauk Hwy
East Moriches, NY 11940-1153
Mailing address
16 Debragga Ave
East Moriches, NY 11940-1463
Phone (631) 745-2909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012819-1 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1639688468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 DEBRAGGA AVE",
"city": "EAST MORICHES",
"state": "NY",
"postal_code": "119401463",
"telephone_number": "631-745-2909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 MONTAUK HWY",
"city": "EAST MORICHES",
"state": "NY",
"postal_code": "119401153",
"telephone_number": "631-874-0571",
"fax_number": "631-745-2909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUINN",
"first_name": "TRACY",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-25",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "012819-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Moriches, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.