Healthcare Provider Details

I. General information

NPI: 1639125685
Provider Name (Legal Business Name): MARIA THERESA J QUILOP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL 2ND FLOOR
BRONX NY
10461-2728
US

IV. Provider business mailing address

560 WHITE PLAINS RD SUITE 500
TARRYTOWN NY
10591-5113
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-4366
  • Fax: 718-863-9743
Mailing address:
  • Phone: 914-333-5877
  • Fax: 914-333-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number141759
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: