Provider Demographics
NPI:1255641700
Name:QUIRK, MICHAEL J (RN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:QUIRK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4051
Mailing Address - Country:US
Mailing Address - Phone:631-981-3887
Mailing Address - Fax:
Practice Address - Street 1:83 PARK ST
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4051
Practice Address - Country:US
Practice Address - Phone:631-981-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409135-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse