Provider Demographics
NPI:1700960614
Name:QUINTONG, VIRGINIA RABARA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:RABARA
Last Name:QUINTONG
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 1:1040 ELLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1316
Mailing Address - Country:US
Mailing Address - Phone:732-574-1849
Mailing Address - Fax:
Practice Address - Street 1:1040 ELLIS PKWY
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1316
Practice Address - Country:US
Practice Address - Phone:732-574-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02933400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3205801Medicaid
NJC56547Medicare UPIN