Healthcare Provider Details

I. General information

NPI: 1992190722
Provider Name (Legal Business Name): HEALTH QUEST MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 ROUTE 32 SUITE4
MODENA NY
12548
US

IV. Provider business mailing address

1351 ROUTE 55 SUITE 200
LAGRANGEVILLE NY
12540-5108
US

V. Phone/Fax

Practice location:
  • Phone: 845-883-5176
  • Fax: 845-883-5177
Mailing address:
  • Phone: 845-475-9661
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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