1902804479 NPI number — DR. GARY LAWRENCE QUARTELLO DPM

Table of content: DR. GARY LAWRENCE QUARTELLO DPM (NPI 1902804479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804479 NPI number — DR. GARY LAWRENCE QUARTELLO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUARTELLO
Provider First Name:
GARY
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902804479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
369 SPRINGFIELD AVE
Provider Second Line Business Mailing Address:
PO BOX 97
Provider Business Mailing Address City Name:
BERKELEY HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07922-1170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-665-2772
Provider Business Mailing Address Fax Number:
908-665-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
369 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07922-1170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-665-2772
Provider Business Practice Location Address Fax Number:
908-665-0842
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  25MD00140100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15852 . This is a "MASTERCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2092808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1040011-027 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 480024315 . This is a "RAILROADMEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK8635 . This is a "FIRST OPTION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NEIC#23342 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: UP155 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 03000-1401NJ01 . This is a "ANTHEM HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22313390-01 . This is a "PRUDENTIAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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