Provider Demographics
NPI:1225131592
Name:QUIJADA, REUCAR (MD)
Entity Type:Individual
Prefix:
First Name:REUCAR
Middle Name:
Last Name:QUIJADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 207TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2645
Mailing Address - Country:US
Mailing Address - Phone:212-544-7777
Mailing Address - Fax:212-544-9660
Practice Address - Street 1:515 W 207TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2645
Practice Address - Country:US
Practice Address - Phone:212-544-7777
Practice Address - Fax:212-544-9660
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1225131592Medicaid