Provider Demographics
NPI:1083041180
Name:QUINN, THERESE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:ELIZABETH
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 210TH ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1951
Mailing Address - Country:US
Mailing Address - Phone:516-659-2118
Mailing Address - Fax:
Practice Address - Street 1:3907 210TH ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1951
Practice Address - Country:US
Practice Address - Phone:516-659-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544502111174400000X
NY353865091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY544502111OtherSPECIAL EDUCATION
NY353865091OtherSPECIAL EDUCATION