Healthcare Provider Details

I. General information

NPI: 1881099844
Provider Name (Legal Business Name): HEALTH QUEST MEDICAL QUEST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 READE PL SUITE 3100
POUGHKEEPSIE NY
12601-3912
US

IV. Provider business mailing address

1351 ROUTE 55
LAGRANGEVILLE NY
12540-5108
US

V. Phone/Fax

Practice location:
  • Phone: 845-214-1900
  • Fax: 845-214-1919
Mailing address:
  • Phone: 845-475-9635
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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