Provider Demographics
NPI:1528569126
Name:QUINTANA, LUIS MANUEL (MS SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3805
Mailing Address - Country:US
Mailing Address - Phone:347-614-7942
Mailing Address - Fax:
Practice Address - Street 1:204 BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3805
Practice Address - Country:US
Practice Address - Phone:347-614-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist