Provider Demographics
NPI:1437122967
Name:ANDREA QUINTANA DO PC
Entity Type:Organization
Organization Name:ANDREA QUINTANA DO PC
Other - Org Name:QUINTANA FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-225-2999
Mailing Address - Street 1:290 S WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4903
Mailing Address - Country:US
Mailing Address - Phone:631-225-2999
Mailing Address - Fax:631-225-2104
Practice Address - Street 1:290 S WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4903
Practice Address - Country:US
Practice Address - Phone:631-225-2999
Practice Address - Fax:631-225-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH45073Medicare UPIN