1992774715 NPI number — DR. SHARON QUAYLE MD

Table of content: DR. SHARON QUAYLE MD (NPI 1992774715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992774715 NPI number — DR. SHARON QUAYLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUAYLE
Provider First Name:
SHARON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1992774715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 ROUTE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-634-8400
Provider Business Mailing Address Fax Number:
845-634-0979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 ROUTE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-634-8400
Provider Business Practice Location Address Fax Number:
845-634-0979
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  200659 , 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: 0619118 . This is a "AETNA HMO ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D0521 . This is a "HEALTHNET ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160049418 . This is a "RAILROAD MEDICARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25G581 . This is a "EMPIRE BC/BS NEW CITY #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 25G583 . This is a "EMPIRE BC/BS STONY PT. #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5696090 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000027172 . This is a "GHI HMO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0201710 . This is a "GHI PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200659 . This is a "HIP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P391430 . This is a "OXFORD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000282 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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