Healthcare Provider Details

I. General information

NPI: 1174684104
Provider Name (Legal Business Name): JULIETTE QUINTERO SOLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N WASHINGTON AVE
BERGENFIELD NJ
07621-1751
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 201-384-0300
  • Fax: 201-384-9518
Mailing address:
  • Phone: 201-384-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number25MA079099
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA079099
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: