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General NPI Number Information
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NPI Number | 1003819418
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Entity Type | Organization
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Legal Business Name | QUENTIN MEDICAL LAB
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 140 58TH ST STE 1E
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City | BROOKLYN
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State | NY
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Zip | 11220-2562
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Country | US
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Telephone | 718-492-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 140 58TH ST STE 1E
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City | BROOKLYN
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State | NY
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Zip | 11220-2562
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Country | US
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Telephone | 718-492-2600
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | MR. MICHAEL PRENDIMANO
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Credential |
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Telephone | 718-492-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 33D0147515
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License Number State | NY
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