Provider Demographics
NPI:1750354288
Name:QUINTANA, ANDREA (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:QUINTANA
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 1:290 S WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4903
Mailing Address - Country:US
Mailing Address - Phone:631-225-2999
Mailing Address - Fax:631-225-2104
Practice Address - Street 1:290 S WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4903
Practice Address - Country:US
Practice Address - Phone:631-225-2999
Practice Address - Fax:631-225-2104
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH45073Medicare UPIN