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General NPI Number Information
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NPI Number | 1578535910
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Entity Type | Individual
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Provider Name | MATTHEW BRETT QUAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 700 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-517-6555
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Fax | 212-472-6796
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Provider Business Mailing Address
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Address Line | 22 WEST 15 ST 21A
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 917-721-4901
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Fax | 212-366-9419
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 216306
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G073273
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | MA70706
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 216306
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License Number State | NY
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