Bryan Howard Quackenbush

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404392 Issued in NY

Practice address

750 Berme Rd
Napanoch, NY 12458-2709

Phone

(845) 647-1670

NPI assigned

Jan 11, 2022

Last updated

Aug 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ulster Correctional Facility

  • Medical Physician Assistant
  • Napanoch, NY
  • NPI 1871985127
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661040000000",
    "number": "1396496436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 BELVEDERE RD",
            "city": "BEACON",
            "state": "NY",
            "postal_code": "125082421",
            "telephone_number": "845-264-9708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 BERME RD",
            "city": "NAPANOCH",
            "state": "NY",
            "postal_code": "124582709",
            "telephone_number": "845-647-1670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Fallsburg",
            "state": "NY",
            "postal_code": "127335308",
            "country_code": "US",
            "telephone_number": "845-434-2080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Belvedere Rd",
            "address_purpose": "LOCATION",
            "city": "Beacon",
            "state": "NY",
            "postal_code": "125082421",
            "country_code": "US",
            "telephone_number": "845-264-9708",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9005 Old River Rd",
            "address_purpose": "LOCATION",
            "city": "Marcy",
            "state": "NY",
            "postal_code": "134033000",
            "country_code": "US",
            "telephone_number": "315-765-3600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUACKENBUSH",
        "first_name": "BRYAN",
        "middle_name": "HOWARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-08-21",
        "certification_date": "2022-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404392",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN676013",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "702414",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helene Michel Dumas, NP-C
• Yaroslava Milov, PA
• Robin Morgan-North, RN
• Moving Mountains Occupational Therapy P C
• Gerald Allen Pulis Jr., LMT
• R Raymond Tartakoff LCSW PC
• Jaime Antonio Rodriguez, LPN
• State of New York Office of State Comptroller (Ulster Pharmacy)
• Raymond Reuben Tartakoff
• Ulster Correctional Facility

• Psychiatric/Mental Health Nurse Practitioner in Napanoch, NY
• Providers in Napanoch, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.