Provider Demographics
NPI:1407039290
Name:GLENN S QUITTELL
Entity Type:Organization
Organization Name:GLENN S QUITTELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-834-1313
Mailing Address - Street 1:2001 PALMER AVE
Mailing Address - Street 2:102
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2468
Mailing Address - Country:US
Mailing Address - Phone:914-834-1313
Mailing Address - Fax:914-834-1318
Practice Address - Street 1:2001 PALMER AVE
Practice Address - Street 2:102
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2468
Practice Address - Country:US
Practice Address - Phone:914-834-1313
Practice Address - Fax:914-834-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY441480202OtherRAILROAD MEDICARE
NY4778960002Medicare NSC