Provider Demographics
NPI:1699785428
Name:QUINTANA, OLGA B (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:B
Last Name:QUINTANA
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 1:57 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2503
Mailing Address - Country:US
Mailing Address - Phone:973-483-5174
Mailing Address - Fax:973-483-7331
Practice Address - Street 1:57 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2503
Practice Address - Country:US
Practice Address - Phone:973-483-5174
Practice Address - Fax:973-483-7331
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03249700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12148OtherAMERIGROUP
NJ0218103Medicaid
NJP-2882660OtherOXFORD
NJ1025474Medicaid
NJC-01740Medicare UPIN
NJ1025474Medicaid