Provider Demographics
NPI:1710195805
Name:QUIMSON, ROMMEL CRUZ (OTR, CHT)
Entity Type:Individual
Prefix:MR
First Name:ROMMEL
Middle Name:CRUZ
Last Name:QUIMSON
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W 16TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6127
Mailing Address - Country:US
Mailing Address - Phone:646-641-4430
Mailing Address - Fax:
Practice Address - Street 1:130 E 35TH ST
Practice Address - Street 2:CARE OF EAST SIDE MEDICAL PRACTICE, PC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3815
Practice Address - Country:US
Practice Address - Phone:212-481-3600
Practice Address - Fax:212-481-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007209-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS7301Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY