Provider Demographics
NPI:1427275569
Name:QUITANGON, GERTIE (MD)
Entity type:Individual
Prefix:DR
First Name:GERTIE
Middle Name:
Last Name:QUITANGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RIVERSIDE BLVD APT 20U
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-1023
Mailing Address - Country:US
Mailing Address - Phone:212-721-0302
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2518632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
NY00695941Medicaid
WI331058Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331978Medicare Oscar/Certification