Provider Demographics
NPI:1316070261
Name:GARY A. TRAGER, MD, LLC
Entity type:Organization
Organization Name:GARY A. TRAGER, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-673-9422
Mailing Address - Street 1:475 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3441
Mailing Address - Country:US
Mailing Address - Phone:631-673-9422
Mailing Address - Fax:
Practice Address - Street 1:475 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3441
Practice Address - Country:US
Practice Address - Phone:631-673-9422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW89061Medicare ID - Type UnspecifiedGROUP PRACTICE