Healthcare Provider Details

I. General information

NPI: 1861763096
Provider Name (Legal Business Name): EDGARD QUINONES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E MAIN ST
WALDEN NY
12586-1554
US

IV. Provider business mailing address

122 E MAIN ST
WALDEN NY
12586-1554
US

V. Phone/Fax

Practice location:
  • Phone: 845-778-0423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGARD QUINONES
Title or Position: PRESIDENT
Credential:
Phone: 845-778-0423