Healthcare Provider Details

I. General information

NPI: 1902804479
Provider Name (Legal Business Name): GARY LAWRENCE QUARTELLO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1170
US

IV. Provider business mailing address

369 SPRINGFIELD AVE PO BOX 97
BERKELEY HEIGHTS NJ
07922-1170
US

V. Phone/Fax

Practice location:
  • Phone: 908-665-2772
  • Fax: 908-665-0842
Mailing address:
  • Phone: 908-665-2772
  • Fax: 908-665-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00140100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: