MEDICARE: ADELLE T QUINTANA MD

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	207N00000X	Dermatology Physician	207656	NY

General Provider Information

NPI Number	:	1386668119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELLE T QUINTANA MD

Provider Business Mailing Address
First Line	:	501 5TH AVE RM 604
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-7832
Country	:	US
Telephone Number	:	212-391-8600
Fax Number	:	212-391-8601

Provider Business Practice Location Address
First Line	:	501 5TH AVE RM 604
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-7832
Country	:	US
Telephone Number	:	212-391-8600
Fax Number	:	212-391-8601

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/18/2022

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