Healthcare Provider Details

I. General information

NPI: 1336441880
Provider Name (Legal Business Name): CELIA LEIGH QUINN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST DEPARTMENT OF PEDIATRICS, ROSENTHAL 4
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST DEPARTMENT OF PEDIATRICS, ROSENTHAL 4
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2487
  • Fax: 718-654-4161
Mailing address:
  • Phone: 718-741-2487
  • Fax: 718-654-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number258225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: