Healthcare Provider Details

I. General information

NPI: 1922266568
Provider Name (Legal Business Name): MCN QUAD HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUNTINGTON QUADRANGLE SUITE 3C-10
MELVILLE NY
11747-4401
US

IV. Provider business mailing address

1200 6TH AVE STE 1800
SEATTLE WA
98101-5300
US

V. Phone/Fax

Practice location:
  • Phone: 631-454-8399
  • Fax: 631-454-8522
Mailing address:
  • Phone: 206-343-6100
  • Fax: 206-812-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4528129
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL MAYER
Title or Position: PRESIDENT
Credential:
Phone: 206-343-6100