Basic Information
| Provider Information | |||||||||
| NPI: | 1245363001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIDDINGTON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | JACQUELINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POINSARD | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | JACQUELINE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12 LINCOLN PL | ||||||||
| Address2: | APT. # 4 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112173583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182304908 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 199 JAY ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112011907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184880100 | ||||||||
| FaxNumber: | 7184880129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.