Healthcare Provider Details

I. General information

NPI: 1821439043
Provider Name (Legal Business Name): SARA JEAN QUINN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA JEAN KLIMOSKI MD

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 530
SYRACUSE NY
13210-1663
US

IV. Provider business mailing address

739 IRVING AVE STE 530
SYRACUSE NY
13210-1663
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-1158
  • Fax: 315-478-3014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number287452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: