Healthcare Provider Details

I. General information

NPI: 1487615548
Provider Name (Legal Business Name): BRIAN MICHAEL QUAIL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEDICAL PARK DR SUITE 102
POMONA NY
10970-3559
US

IV. Provider business mailing address

11 MEDICAL PARK DR SUITE 102
POMONA NY
10970-3559
US

V. Phone/Fax

Practice location:
  • Phone: 800-402-8019
  • Fax:
Mailing address:
  • Phone: 800-402-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number013143
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: