Individual provider Active NPI

Brian Patrick Quinn, MS,PTA

  • Specialist
  • Smithtown, NY
National Provider Identifier
1609089648
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
003304 Issued in NY
Practice address
240 E Main St
Smithtown, NY 11787-2909
Phone
(631) 382-4550
Fax
(631) 382-4559
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 003304 NY Primary

Addresses

Primary practice location

240 E Main St
Smithtown, NY 11787-2909

Mailing address

3880 Worthmor Dr
Seaford, NY 11783-2011
Phone (516) 221-0055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
003304NYMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609089648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 WORTHMOR DR",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117832011",
            "telephone_number": "516-221-0055",
            "fax_number": "631-382-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 E MAIN ST",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872909",
            "telephone_number": "631-382-4550",
            "fax_number": "631-382-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINN",
        "first_name": "BRIAN",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "MS,PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "003304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.