Provider Demographics
NPI:1124421268
Name:JORGE D QUINTANA MD
Entity type:Organization
Organization Name:JORGE D QUINTANA MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-715-1310
Mailing Address - Street 1:180 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3122
Mailing Address - Country:US
Mailing Address - Phone:973-715-1310
Mailing Address - Fax:908-290-3105
Practice Address - Street 1:1203 W SAINT GEORGES AVE
Practice Address - Street 2:1FLOOR LEFT SIDE UNIT
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6167
Practice Address - Country:US
Practice Address - Phone:973-715-1310
Practice Address - Fax:908-290-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034488TJKMedicare PIN