Healthcare Provider Details

I. General information

NPI: 1295662443
Provider Name (Legal Business Name): SEBASTIAN SEMBOS QUIANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY
CAMDEN NJ
08103-1211
US

IV. Provider business mailing address

1208 PICCARD CT
DEPTFORD NJ
08096-5124
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: