Healthcare Provider Details

I. General information

NPI: 1124191549
Provider Name (Legal Business Name): MARY JO QUATROCHI PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

35 LIBERTY AVE
NEW ROCHELLE NY
10801-7144
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6678
  • Fax:
Mailing address:
  • Phone: 914-636-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number345819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: