Provider Demographics
NPI:1639267776
Name:QUINES, EMILIO P JR (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:P
Last Name:QUINES
Suffix:JR
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 1:86 ANCHORAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-854-1781
Mailing Address - Fax:631-854-1783
Practice Address - Street 1:1556 STRAIGHT PATH
Practice Address - Street 2:MARTIN LUTHER KING JR HEALTH CENTER
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798
Practice Address - Country:US
Practice Address - Phone:631-854-1781
Practice Address - Fax:631-854-1783
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111516207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
80095866OtherRR
NY00200766Medicaid
EQ06257410Medicare ID - Type Unspecified
NY00200766Medicaid