Healthcare Provider Details

I. General information

NPI: 1215384482
Provider Name (Legal Business Name): JUDY QUINONES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 SECOND AVE
NEW YORK NY
10035
US

IV. Provider business mailing address

2367 2ND AVE
NEW YORK NY
10035-3108
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 212-722-7618
Mailing address:
  • Phone: 212-876-2300
  • Fax: 212-722-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: