1720001795 NPI number — DR. EMILY S QUEENAN M.D

Table of content: DR. EMILY S QUEENAN M.D (NPI 1720001795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720001795 NPI number — DR. EMILY S QUEENAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUEENAN
Provider First Name:
EMILY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNYDER
Provider Other First Name:
EMILY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720001795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 EAST AVE
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14610-1657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-494-3064
Provider Business Mailing Address Fax Number:
888-494-3064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14610-1657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-494-3064
Provider Business Practice Location Address Fax Number:
888-494-3064
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  240748 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00355353 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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