Basic Information
Provider Information | |||||||||
NPI: | 1760951115 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HEALTH QUEST MEDICAL PRACTICE, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HQMP SHARON PCP 29 HOSP. | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1351 ROUTE 55 STE 200 | ||||||||
Address2: |   | ||||||||
City: | LAGRANGEVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 125405128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8454759661 | ||||||||
FaxNumber: | 8454759938 | ||||||||
Practice Location | |||||||||
Address1: | 29 HOSPITAL HILL RD STE 1400 | ||||||||
Address2: |   | ||||||||
City: | SHARON | ||||||||
State: | CT | ||||||||
PostalCode: | 060692095 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8603647029 | ||||||||
FaxNumber: | 8603647079 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/15/2018 | ||||||||
LastUpdateDate: | 11/08/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERZINSKY | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
AuthorizedOfficialTelephone: | 8454759661 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   | 207R00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.