Provider Demographics
NPI:1386758472
Name:QUINN, KERRY E (DPM)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:E
Last Name:QUINN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2421
Mailing Address - Country:US
Mailing Address - Phone:845-735-4720
Mailing Address - Fax:845-735-4735
Practice Address - Street 1:17 S WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2421
Practice Address - Country:US
Practice Address - Phone:845-735-4720
Practice Address - Fax:845-735-4735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005409213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01918198Medicaid
NY01918198Medicaid
U74002Medicare UPIN
PA9221Medicare ID - Type Unspecified