Provider Demographics
NPI:1316939077
Name:QUINN, ANTONIA C (DO)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:C
Last Name:QUINN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LENOX RD
Mailing Address - Street 2:BOX 1262
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2017
Mailing Address - Country:US
Mailing Address - Phone:718-245-4790
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-245-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231062-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02611021Medicaid
NY0208Q1Medicare ID - Type Unspecified
NY02611021Medicaid