1932277415 NPI number — MATTHEW B. QUAN, M.D., P.C.

Table of content: NATALIE GONZALEZ (NPI 1841910502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932277415 NPI number — MATTHEW B. QUAN, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW B. QUAN, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932277415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-517-6555
Provider Business Mailing Address Fax Number:
212-472-6796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-517-6555
Provider Business Practice Location Address Fax Number:
212-472-6796
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUAN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
BRETT
Authorized Official Title or Position:
DERMATOLOGIST DOCTOR
Authorized Official Telephone Number:
212-517-6555

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  216306 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189036P . This is a "HIP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 216306 . This is a "MAGNACARE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 216306 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C3691 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3K1153 . This is a "BLUECROSS PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4673219 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3408075 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2527966 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2299453 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0102163306NY02 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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