Provider Demographics
NPI:1306816103
Name:QUIWA, JOSE ESCUETA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ESCUETA
Last Name:QUIWA
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 1:8502 66TH RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5212
Mailing Address - Country:US
Mailing Address - Phone:718-426-5202
Mailing Address - Fax:718-897-2874
Practice Address - Street 1:8502 66TH RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5212
Practice Address - Country:US
Practice Address - Phone:718-426-5202
Practice Address - Fax:718-897-2874
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1702272080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM113254834OtherCARE PLUS
NY290890101OtherHEALTHPLUS
NY0014346OtherGHI
NY113254834Other1199
NY113254834OtherMAGNACARE
NY01021732Medicaid
NY29344POtherHIP
NY2C7160OtherHEALTHNET/ACS
NYDP327OtherOXFORD
NY113254834OtherHORIZON
NY113254834OtherUNITED HEALTHCARE
NY120550OtherUNITED HEALTHCARE(MED).
NY3663457-001OtherCIGNA
NY49143OtherMDNY
NY4235224OtherAETNA
NY471Z61OtherBC/BS
NY40426017707OtherFIDELISCARE