MEDICARE: QUAUTUM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1609114602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAUTUM LLC

Provider Business Mailing Address
First Line	:	419 SARATOGA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4708
Country	:	US
Telephone Number	:	917-631-8500
Fax Number	:	347-627-5444

Provider Business Practice Location Address
First Line	:	419 SARATOGA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4708
Country	:	US
Telephone Number	:	917-631-8500
Fax Number	:	347-627-5444

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARSHALL PEACHES
Credential	:
Telephone Number	:	917-631-8500

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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Directions to “QUAUTUM LLC ” Practice Location

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