Provider Demographics
NPI:1346756566
Name:MALONEY, QUINN
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:MALONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2997
Mailing Address - Country:US
Mailing Address - Phone:585-395-2414
Mailing Address - Fax:585-395-2559
Practice Address - Street 1:350 NEW CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2997
Practice Address - Country:US
Practice Address - Phone:585-395-2414
Practice Address - Fax:585-395-2559
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily