Provider Demographics
NPI:1114339322
Name:QUAN, MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:QUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 BRIDGE ST
Mailing Address - Street 2:APT 11B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5210
Mailing Address - Country:US
Mailing Address - Phone:917-733-2505
Mailing Address - Fax:
Practice Address - Street 1:388 BRIDGE ST
Practice Address - Street 2:APT 11B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5210
Practice Address - Country:US
Practice Address - Phone:917-733-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2744932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine