Provider Demographics
NPI:1851791644
Name:QUINONEZ, JESSENIA A (MT)
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:A
Last Name:QUINONEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 LORNA PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1325
Mailing Address - Country:US
Mailing Address - Phone:917-704-2969
Mailing Address - Fax:
Practice Address - Street 1:2552 LORNA PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1325
Practice Address - Country:US
Practice Address - Phone:917-704-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist