MEDICARE: DIANE QUIROGA ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	10-180	NJ

General Provider Information

NPI Number	:	1346500907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE QUIROGA ATR-BC

Provider Business Mailing Address
First Line	:	500 MORRIS AVE
Second Line	:	SUITE 105
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1027
Country	:	US
Telephone Number	:	908-397-9118
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MORRIS AVE
Second Line	:	SUITE 105
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1027
Country	:	US
Telephone Number	:	908-397-9118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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