Provider Demographics
NPI:1669819488
Name:QUALITY OBS ALLIANCE, LLC
Entity Type:Organization
Organization Name:QUALITY OBS ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WINAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-855-8354
Mailing Address - Street 1:224 7TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5781
Mailing Address - Country:US
Mailing Address - Phone:516-855-8354
Mailing Address - Fax:516-873-6548
Practice Address - Street 1:224 7TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5781
Practice Address - Country:US
Practice Address - Phone:516-855-8354
Practice Address - Fax:516-873-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization