Provider Demographics
NPI:1598205767
Name:QUINTANA, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 EVERGREEN AVE
Mailing Address - Street 2:18K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4507
Mailing Address - Country:US
Mailing Address - Phone:646-418-3317
Mailing Address - Fax:
Practice Address - Street 1:950 EVERGREEN AVE
Practice Address - Street 2:18K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4507
Practice Address - Country:US
Practice Address - Phone:646-418-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist