Healthcare Provider Details

I. General information

NPI: 1790768935
Provider Name (Legal Business Name): NANCYANN QUIMBY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIVER ST SUITE 202
VALATIE NY
12184-9694
US

IV. Provider business mailing address

1301 RIVER ST SUITE 202
VALATIE NY
12184-9694
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-1331
  • Fax: 518-758-1394
Mailing address:
  • Phone: 518-758-1331
  • Fax: 518-758-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: