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NPI Code Detail

MEDICARE: KAMI QUINN MEDICAL DOCTOR PLLC

MEDICARE: KAMI QUINN MEDICAL DOCTOR PLLC
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
1207Q00000XFamily Medicine Physician222984NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11114936317OTHERNYINDIVIDUAL NPI NUMBER

General Provider Information

NPI Number : 1265610166
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAMI QUINN MEDICAL DOCTOR PLLC
Provider Business Mailing Address
First Line : 76 SOUTHAVEN AVE
Second Line : SUITE 4
City : MEDFORD
State : NY
Zip : 11763-3745
Country : US
Telephone Number : 631-569-4055
Fax Number : 631-569-4056
Provider Business Practice Location Address
First Line : 76 SOUTHAVEN AVE
Second Line : SUITE 4
City : MEDFORD
State : NY
Zip : 11763-3745
Country : US
Telephone Number : 631-569-4055
Fax Number : 631-569-4056
Authorized Official
Title or Position : OWNER FAMILY PRACTICE PHYSICIAN
Name : DR. KAMI QUINN BARRY
Credential : D.O.
Telephone Number : 631-569-4055
Provider Enumeration Date : 02/04/2008
Last Update Date : 02/06/2008

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