Provider Demographics
NPI:1275654162
Name:QUINONES MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:QUINONES MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-570-4882
Mailing Address - Street 1:1007 FARMINGTON AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2133
Mailing Address - Country:US
Mailing Address - Phone:860-570-4882
Mailing Address - Fax:860-570-4885
Practice Address - Street 1:1007 FARMINGTON AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-570-4882
Practice Address - Fax:860-570-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044164207R00000X
CT002324363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004269991Medicaid
CT004269983Medicaid