Individual
TRACY COLANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
689 NICOLLS RD, DEER PARK, NY 11729-2725
(631) 300-6153
Mailing address
689 NICOLLS RD, DEER PARK, NY 11729-2725
(631) 300-6153
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NY
171W00000X
Contractor
Primary
281474091
NY
Other
Enumeration date
01/26/2009
Last updated
12/06/2023
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