Healthcare Provider Details

I. General information

NPI: 1619859386
Provider Name (Legal Business Name): MADELINE QUICK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3456
  • Fax:
Mailing address:
  • Phone: 607-547-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: