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General NPI Number Information
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NPI Number | 1962537175
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Entity Type | Individual
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Provider Name | HAYLEY CR QUELLER MD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 6 TECHNOLOGY DR STE 100
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4079
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Country | US
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Telephone | 631-689-6698
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Fax | 631-751-5548
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Provider Business Mailing Address
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Address Line | 6 TECHNOLOGY DR STE 100
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City | EAST SETAUKET
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State | NY
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Zip | 11733-4079
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Country | US
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Telephone | 631-689-6698
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Fax | 631-751-5548
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 253907
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 253907
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C1-0008458
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C7-0002950
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 253907
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License Number State | NY
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