Healthcare Provider Details

I. General information

NPI: 1790779825
Provider Name (Legal Business Name): GUILLERMO QUETELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRITTONFIELD PKWY STE A125
EAST SYRACUSE NY
13057-9230
US

IV. Provider business mailing address

5000 BRITTONFIELD PKWY STE A125
EAST SYRACUSE NY
13057-9230
US

V. Phone/Fax

Practice location:
  • Phone: 315-802-2601
  • Fax: 315-802-6933
Mailing address:
  • Phone: 315-766-1101
  • Fax: 315-282-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number188329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: