Provider Demographics
NPI:1457021511
Name:QUIMING, DAN ANGELO
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:ANGELO
Last Name:QUIMING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733-2705
Mailing Address - Country:US
Mailing Address - Phone:732-691-1449
Mailing Address - Fax:
Practice Address - Street 1:827 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-2705
Practice Address - Country:US
Practice Address - Phone:732-691-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15026400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered