Provider Demographics
NPI:1578052668
Name:QUIGLEY, BENNETT ERIN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:ERIN
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1386
Mailing Address - Country:US
Mailing Address - Phone:315-886-2738
Mailing Address - Fax:
Practice Address - Street 1:13 OAK DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1338
Practice Address - Country:US
Practice Address - Phone:315-886-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0029072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer