Provider Demographics
NPI:1740219161
Name:QUINTAVALLE, PAUL R JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:QUINTAVALLE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 HADDONFIELD BERLIN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3572
Mailing Address - Country:US
Mailing Address - Phone:856-858-0180
Mailing Address - Fax:858-869-3080
Practice Address - Street 1:69 HADDONFIELD BERLIN RD STE 1
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3572
Practice Address - Country:US
Practice Address - Phone:856-858-0180
Practice Address - Fax:858-869-3080
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001056213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1735501Medicaid
NJQU003671Medicare ID - Type Unspecified
NJ1735501Medicaid