Provider Demographics
NPI:1770799215
Name:QUEZADA, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 11 ROOSEVELT AVE.
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2331
Mailing Address - Country:US
Mailing Address - Phone:718-898-5200
Mailing Address - Fax:718-898-3673
Practice Address - Street 1:8714 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2036
Practice Address - Country:US
Practice Address - Phone:718-296-2020
Practice Address - Fax:718-296-1781
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY296263208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01814617Medicaid