Provider Demographics
NPI:1891701991
Name:QUARTARARO, MICHAEL MATTHEW (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:QUARTARARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2684
Mailing Address - Country:US
Mailing Address - Phone:518-363-0202
Mailing Address - Fax:518-363-0711
Practice Address - Street 1:402 ROWLAND ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2684
Practice Address - Country:US
Practice Address - Phone:518-363-0202
Practice Address - Fax:518-363-0711
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10029107OtherCDPHP
NY10029107OtherCDPHP
NYU46144Medicare UPIN