Healthcare Provider Details

I. General information

NPI: 1396662110
Provider Name (Legal Business Name): JUAN C QUINTANA COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

4521 COTTAGE PL APT D4
UNION CITY NJ
07087-2761
US

V. Phone/Fax

Practice location:
  • Phone: 347-970-2188
  • Fax:
Mailing address:
  • Phone: 973-979-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011812-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: