Healthcare Provider Details

I. General information

NPI: 1275879355
Provider Name (Legal Business Name): PRIAPEX HEALTH & FITNESS P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 PINE ST
MANCHESTER NH
03104-3559
US

IV. Provider business mailing address

25 MARSHALL STREET APT 2C
NORWALK CT
06854-2275
US

V. Phone/Fax

Practice location:
  • Phone: 917-566-3554
  • Fax: 203-274-6713
Mailing address:
  • Phone: 917-566-3554
  • Fax: 203-274-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number049930-23
License Number StateNH

VIII. Authorized Official

Name: DR. THOMAS MCQUAID
Title or Position: OWNER/MANAGER
Credential: DNP
Phone: 917-566-3554