Provider Demographics
NPI:1609089648
Name:QUINN, BRIAN PATRICK (MS,PTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:QUINN
Suffix:
Gender:M
Credentials:MS,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 WORTHMOR DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2011
Mailing Address - Country:US
Mailing Address - Phone:516-221-0055
Mailing Address - Fax:631-382-4550
Practice Address - Street 1:240 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2909
Practice Address - Country:US
Practice Address - Phone:631-382-4550
Practice Address - Fax:631-382-4559
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist