Healthcare Provider Details

I. General information

NPI: 1780960161
Provider Name (Legal Business Name): THOMAS VINCENT QUIGLEY ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 JORALEMON ST
BROOKLYN NY
11201-4312
US

IV. Provider business mailing address

2161 STEINWAY ST APT C2
ASTORIA NY
11105-1829
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-0200
  • Fax:
Mailing address:
  • Phone: 516-298-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: