Individual
MR. TRACEY G TOBACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
43 GRAND ST, KINGSTON, NY 12401-3933
(845) 339-3338
(845) 340-1074
Mailing address
43 GRAND ST, KINGSTON, NY 12401-3933
(845) 339-3338
(845) 340-1074
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
000465
CT
213E00000X
Podiatrist
Primary
N004154-3
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01941551
—
NY
Enumeration date
07/14/2005
Last updated
07/08/2007
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