Provider Demographics
NPI:1962278903
Name:BARTON-HERISHEN, TRACEY (LMT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BARTON-HERISHEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2104
Mailing Address - Country:US
Mailing Address - Phone:201-390-6787
Mailing Address - Fax:
Practice Address - Street 1:82 8TH ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2104
Practice Address - Country:US
Practice Address - Phone:201-390-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00598600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist