Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MEDICAL MASSAGE | NJ |
NPI | 1891076477 |
---|---|
Provider Name | Ms. Tracy A Marciano |
First Address | West Seneca, NY 14224-1501 |
Second Address | West Seneca, NY 14224-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 17/09/2012 |