Healthcare Provider Details

I. General information

NPI: 1467861930
Provider Name (Legal Business Name): HEALTH QUEST MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MAIDEN LN
KINGSTON NY
12401-4508
US

IV. Provider business mailing address

1351 ROUTE 55 SUITE 200
LAGRANGEVILLE NY
12540-5108
US

V. Phone/Fax

Practice location:
  • Phone: 845-331-5326
  • Fax: 845-331-5837
Mailing address:
  • Phone: 845-475-9635
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD TATELBAUM
Title or Position: PRESIDENT
Credential: MD
Phone: 845-475-9635