Provider Demographics
NPI:1982807483
Name:QUARTERMAINE, RENATA MELISSA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:MELISSA
Last Name:QUARTERMAINE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PARKWAY RD APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3612
Mailing Address - Country:US
Mailing Address - Phone:914-844-4228
Mailing Address - Fax:
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-2183
Practice Address - Fax:212-523-8315
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005278-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005278-1OtherLICENSE