MEDICARE: ERIC WING QUAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	019570-1	NY

General Provider Information

NPI Number	:	1073613667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WING QUAN PT

Provider Business Mailing Address
First Line	:	5702 MONOCACY DR
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-8236
Country	:	US
Telephone Number	:	610-837-3928
Fax Number	:	212-239-0911

Provider Business Practice Location Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 416
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	917-528-3546
Fax Number	:	212-239-0911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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