Provider Demographics
NPI:1134856289
Name:PARENTS BABY TRIAD
Entity type:Organization
Organization Name:PARENTS BABY TRIAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-733-2505
Mailing Address - Street 1:1 TRANQUILITY CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2413
Mailing Address - Country:US
Mailing Address - Phone:917-733-2505
Mailing Address - Fax:
Practice Address - Street 1:1 TRANQUILITY CT
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2413
Practice Address - Country:US
Practice Address - Phone:917-733-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA11429500OtherNJ STATE LICENSE