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General NPI Number Information
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NPI Number | 1346947967
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Entity Type | Organization
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Legal Business Name | QUARTET MEDICAL GROUP OF NEW JERSEY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 1 GATEWAY CTR STE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5323
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Country | US
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Telephone | 267-999-9534
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Fax |
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Provider Business Mailing Address
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Address Line | 228 PARK AVE S PMB 36149
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City | NEW YORK
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State | NY
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Zip | 10003-1879
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Country | US
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Telephone | 267-999-9534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT WILSON
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Credential | MD
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Telephone | 267-999-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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