Provider Demographics
NPI:1265610166
Name:KAMI QUINN MEDICAL DOCTOR PLLC
Entity type:Organization
Organization Name:KAMI QUINN MEDICAL DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-569-4055
Mailing Address - Street 1:76 SOUTHAVEN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3745
Mailing Address - Country:US
Mailing Address - Phone:631-569-4055
Mailing Address - Fax:631-569-4056
Practice Address - Street 1:76 SOUTHAVEN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3745
Practice Address - Country:US
Practice Address - Phone:631-569-4055
Practice Address - Fax:631-569-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1114936317OtherINDIVIDUAL NPI NUMBER