Provider Demographics
NPI:1083922116
Name:QUITADAMO, JENNIFER A (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:QUITADAMO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 DEMAREST AVE
Mailing Address - Street 2:APT 11
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1728
Mailing Address - Country:US
Mailing Address - Phone:845-825-7779
Mailing Address - Fax:
Practice Address - Street 1:84 DEMAREST AVE
Practice Address - Street 2:APT 11
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1728
Practice Address - Country:US
Practice Address - Phone:845-825-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004402-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist