Provider Demographics
NPI:1275879355
Name:PRIAPEX HEALTH & FITNESS P.L.L.C.
Entity Type:Organization
Organization Name:PRIAPEX HEALTH & FITNESS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUAID
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:917-566-3554
Mailing Address - Street 1:25 MARSHALL STREET
Mailing Address - Street 2:APT 2C
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2275
Mailing Address - Country:US
Mailing Address - Phone:917-566-3554
Mailing Address - Fax:203-274-6713
Practice Address - Street 1:604 PINE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3559
Practice Address - Country:US
Practice Address - Phone:917-566-3554
Practice Address - Fax:203-274-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049930-23261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care