Provider Demographics
NPI:1528201035
Name:QUACH, TONY (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:QUACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56-45 MAIN ST
Mailing Address - Street 2:4TH FLOOR SOUTH
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-6824
Mailing Address - Fax:
Practice Address - Street 1:56-45 MAIN ST
Practice Address - Street 2:4TH FLOOR SOUTH
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239205207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02993566OtherMEDICAID GROUP
NYP00871365OtherRAILROAD MEDICARE
NY03123580Medicaid
NY00669OtherMEDICARE GROUP NUMBER
NY03123580Medicaid