Healthcare Provider Details

I. General information

NPI: 1811947187
Provider Name (Legal Business Name): SETH ROBERT QUELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANKLIN AVE
NUTLEY NJ
07110-3224
US

IV. Provider business mailing address

45 FRANKLIN AVE
NUTLEY NJ
07110-3224
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-0111
  • Fax: 973-235-0110
Mailing address:
  • Phone: 973-751-0111
  • Fax: 973-235-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number239796
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number25MA07432800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: