Provider Demographics
NPI:1003819418
Name:QUENTIN MEDICAL LAB
Entity Type:Organization
Organization Name:QUENTIN MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENDIMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-492-2600
Mailing Address - Street 1:140 58TH ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2562
Mailing Address - Country:US
Mailing Address - Phone:718-492-2600
Mailing Address - Fax:
Practice Address - Street 1:140 58TH ST
Practice Address - Street 2:STE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2562
Practice Address - Country:US
Practice Address - Phone:718-492-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0147515291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN240153OtherWELLCARE
NYNY3961OtherHEALTHNET
NY000099801OtherAMERICHOICE
NY10200466OtherAMERIGROUP
NY01794774Medicaid
NY01794774Medicaid