Provider Demographics
NPI:1215540182
Name:QUANE, PATRICK (HCP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:QUANE
Suffix:
Gender:M
Credentials:HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4860 S 74TH ST # A-02
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4359
Practice Address - Country:US
Practice Address - Phone:414-281-7484
Practice Address - Fax:414-281-7562
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03427237700000X
WINO.1645-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist