Burgess, Traci
Burgess, Traci is an sole proprietor health care provider with primary practice located at 5014 Fort Hamilton Pkwy , Brooklyn NY 11219-3324. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Burgess, Traci can be contacted via phone (718) 283-7979.Contact Information
Primary practice address
5014 Fort Hamilton Pkwy
Brooklyn NY 11219-3324
Phone: (718) 283-7979
Fax: (718) 635-8977
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 194808-1 | New York |
Profile Details
| NPI number | 1508863424 |
|---|---|
| LBN Legal business name | Burgess, Traci |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Jan 30th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508863424 | NPPES |
| New York | MEDICAID | 01589913 |
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