Provider Demographics
NPI:1982014924
Name:QUINN, KELLY BROOKE (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BROOKE
Last Name:QUINN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 STATE ROUTE 35 STE 208
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5919
Mailing Address - Country:US
Mailing Address - Phone:732-747-5500
Mailing Address - Fax:
Practice Address - Street 1:225 STATE ROUTE 35 STE 208
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015927207N00000X, 207R00000X
NJ25MB10251100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine