Healthcare Provider Details

I. General information

NPI: 1164625901
Provider Name (Legal Business Name): EVAN DANIEL QUELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE FL 6
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE FL 6
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-6770
  • Fax: 212-754-0369
Mailing address:
  • Phone: 212-752-6770
  • Fax: 212-754-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number2673751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: