Basic Information
| Provider Information | |||||||||
| NPI: | 1386020766 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH QUEST MEDICAL PRACTICE, PC | ||||||||
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| OtherOrganizationName: | BREAST SURGERY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| 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 | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452141840 | ||||||||
| FaxNumber: | 8452141845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2015 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRUGER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8454759635 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.