Basic Information
Provider Information
NPI: 1356702393
EntityType: 2
ReplacementNPI:  
OrganizationName: HEALTH QUEST MEDICAL PRACTICE, PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ENDOCRINOLOGY - 21 READE
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1351 ROUTE 55
Address2: SUITE 200
City: LAGRANGEVILLE
State: NY
PostalCode: 125405108
CountryCode: US
TelephoneNumber: 8454759661
FaxNumber: 8454759938
Practice Location
Address1: 21 READE PL STE 1100
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126013986
CountryCode: US
TelephoneNumber: 8454852500
FaxNumber: 8454852300
Other Information
ProviderEnumerationDate: 03/18/2016
LastUpdateDate: 04/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DOYLE
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP MEDICAL AFFAIRS
AuthorizedOfficialTelephone: 8454759661
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate: 04/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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