Healthcare Provider Details

I. General information

NPI: 1235214693
Provider Name (Legal Business Name): PATRICIA M MCQUADE-KOORS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG - MAP 3400 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-8888
  • Fax:
Mailing address:
  • Phone: 718-920-8888
  • Fax: 718-519-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number118464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: