Provider Demographics
NPI:1558865576
Name:QUINTERO, SAMUEL LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LUIS
Last Name:QUINTERO
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:HSC LEVEL 16, DOM
Mailing Address - Street 2:SUNY STONY BROOK
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HSC LEVEL 16, DOM
Practice Address - Street 2:SUNY STONY BROOK
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:12794
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program