Provider Demographics
NPI:1992190722
Name:HEALTH QUEST MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:HEALTH QUEST MEDICAL PRACTICE, PC
Other - Org Name:MODENA PCP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TATELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-475-9635
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:2044 ROUTE 32
Practice Address - Street 2:SUITE4
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-5176
Practice Address - Fax:845-883-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty