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General NPI Number Information
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NPI Number | 1194289140
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Entity Type | Individual
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Provider Name | DERRICK MCQUISTON PT
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 622 W 168TH ST PH 11-102
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City | NEW YORK
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State | NY
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Zip | 10032-3720
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Country | US
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Telephone | 212-336-3330
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Fax | 212-336-3344
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Provider Business Mailing Address
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Address Line | 2600 NETHERLAND AVE APT 3009
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City | BRONX
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State | NY
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Zip | 10463-4817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 043716
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License Number State | NY
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