Provider Demographics
NPI:1689936379
Name:QUIAMBAO, EDITHA
Entity Type:Individual
Prefix:MS
First Name:EDITHA
Middle Name:
Last Name:QUIAMBAO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EDITHA
Other - Middle Name:
Other - Last Name:QUIAMBAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASPECIAL EDUCATION
Mailing Address - Street 1:28 NORTH CT
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2111
Mailing Address - Country:US
Mailing Address - Phone:917-745-7464
Mailing Address - Fax:
Practice Address - Street 1:28 NORTH CT
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2111
Practice Address - Country:US
Practice Address - Phone:917-745-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist