Provider Demographics
NPI:1245271048
Name:QUACKENBUSH, GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3004
Mailing Address - Country:US
Mailing Address - Phone:201-694-0674
Mailing Address - Fax:
Practice Address - Street 1:56 DOWNEY DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3004
Practice Address - Country:US
Practice Address - Phone:201-694-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060685002085U0001X, 2085R0202X, 2085P0229X, 207ZC0500X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF84894Medicare UPIN
NJ128942Medicare ID - Type Unspecified