Provider Demographics
NPI:1104569722
Name:QUINN, MADELEINE JEAN (RDN)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:JEAN
Last Name:QUINN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 THE RDG
Mailing Address - Street 2:
Mailing Address - City:PLANDOME
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1423
Mailing Address - Country:US
Mailing Address - Phone:516-637-1188
Mailing Address - Fax:
Practice Address - Street 1:400 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3815
Practice Address - Country:US
Practice Address - Phone:516-562-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered