Healthcare Provider Details

I. General information

NPI: 1972410611
Provider Name (Legal Business Name): JENNIFER QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 NORTHERN BLVD STE 202
GREAT NECK NY
11021-5310
US

IV. Provider business mailing address

PO BOX 660145
FRESH MEADOWS NY
11366-0145
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-5114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360499-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: