Provider Demographics
NPI:1942460514
Name:QUINLAN, JACK FRANCIS JR (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:FRANCIS
Last Name:QUINLAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 E CHESTNUT AVE
Mailing Address - Street 2:PENN CARDIOLOGY VINELAND
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5843
Mailing Address - Country:US
Mailing Address - Phone:856-692-7979
Mailing Address - Fax:856-794-9479
Practice Address - Street 1:1076 E CHESTNUT AVE
Practice Address - Street 2:1076 E CHESTNUT AVE
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5843
Practice Address - Country:US
Practice Address - Phone:856-692-7979
Practice Address - Fax:856-794-9479
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08562300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00833740OtherRAILROAD MEDICARE
NJ1942460514OtherAMERIHEALTH
NJ9077287OtherAETNA
NJ171943CSBMedicare PIN