Provider Demographics
NPI:1932277415
Name:MATTHEW B. QUAN, M.D., P.C.
Entity Type:Organization
Organization Name:MATTHEW B. QUAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-6555
Mailing Address - Street 1:700 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4930
Mailing Address - Country:US
Mailing Address - Phone:212-517-6555
Mailing Address - Fax:212-472-6796
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4930
Practice Address - Country:US
Practice Address - Phone:212-517-6555
Practice Address - Fax:212-472-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216306207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY189036POtherHIP PROVIDER NUMBER
NY216306OtherMAGNACARE PROVIDER NUMBER
NY216306OtherLICENSE NUMBER
NY3C3691OtherHEALTHNET
NY3K1153OtherBLUECROSS PROVIDER NUMBER
NY4673219OtherAETNA
NY3408075OtherAETNA PROVIDER NUMBER
NYP2527966OtherOXFORD PROVIDER NUMBER
NY2299453OtherGHI PROVIDER NUMBER
NY0102163306NY02OtherANTHEM PROVIDER NUMBER
NY=========OtherUNITED HEALTHCARE PROVIDE
NY3K1153OtherBLUECROSS PROVIDER NUMBER
NY216306OtherLICENSE NUMBER
NY=========OtherTAX IDENTIFICATION NUMBER
NY4673219OtherAETNA
NYW01981Medicare PIN
NY=========OtherUNITED HEALTHCARE PROVIDE