Provider Demographics
NPI:1689610859
Name:QUIAMBAO, ADONIS ABRIL M
Entity Type:Individual
Prefix:
First Name:ADONIS
Middle Name:ABRIL M
Last Name:QUIAMBAO
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 1:346 CATOR AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2004
Mailing Address - Country:US
Mailing Address - Phone:201-936-0565
Mailing Address - Fax:201-915-0464
Practice Address - Street 1:346 CATOR AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2004
Practice Address - Country:US
Practice Address - Phone:201-936-0565
Practice Address - Fax:201-915-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01132100225100000X
NY023966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14J11Medicare PIN
NYQ14J1Q81L1Medicare PIN