Healthcare Provider Details

I. General information

NPI: 1245271048
Provider Name (Legal Business Name): GAIL QUACKENBUSH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 DOWNEY DR
TENAFLY NJ
07670-3004
US

IV. Provider business mailing address

56 DOWNEY DR
TENAFLY NJ
07670-3004
US

V. Phone/Fax

Practice location:
  • Phone: 201-694-0674
  • Fax:
Mailing address:
  • Phone: 201-694-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number25MA06068500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA06068500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number25MA06068500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA06068500
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number25MA06068500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: