Provider Demographics
NPI:1790768935
Name:QUIMBY, NANCYANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:NANCYANN
Middle Name:
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RIVER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-9694
Mailing Address - Country:US
Mailing Address - Phone:518-758-1331
Mailing Address - Fax:518-758-1394
Practice Address - Street 1:1301 RIVER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-9694
Practice Address - Country:US
Practice Address - Phone:518-758-1331
Practice Address - Fax:518-758-1394
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004802213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001665OtherCDPHP
NYPJ3811OtherEBCBS
NY54381OtherMVP
NY54381OtherMVP
NYU01829Medicare UPIN