Basic Information
| Provider Information | |||||||||
| NPI: | 1104407329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCQUADE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 529 LORETTA ST | ||||||||
| Address2: | |||||||||
| City: | TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141508711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165349059 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 BARTON ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142131573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168816191 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2021 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.