Individual
GRACE A TACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
234 E 149TH ST FL 4, BRONX, NY 10451-5504
(718) 579-5800
Mailing address
234 E 149TH ST FL 4, BRONX, NY 10451-5504
(718) 579-5800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
330740
NY
Other
Enumeration date
04/30/2021
Last updated
11/12/2024
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