Basic Information
| Provider Information | |||||||||
| NPI: | 1982220737 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH QUEST MEDICAL PRACTICE, PC | ||||||||
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| OtherOrganizationName: | HQMP KINGSTON BARIATRICS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759661 | ||||||||
| FaxNumber: | 8454759938 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 ULSTER AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124011517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458714275 | ||||||||
| FaxNumber: | 8458714362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERZINSKY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8454759661 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207RB0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine |
No ID Information.