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General NPI Number Information
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NPI Number | 1467492322
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Entity Type | Organization
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Legal Business Name | CARL G. QUILLEN, M.D. P.A.
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 2040 MILLBURN AVE SUITE 405
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3726
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Country | US
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Telephone | 973-763-2320
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Fax | 973-763-4648
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Provider Business Mailing Address
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Address Line | 2040 MILLBURN AVE SUITE 405
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3726
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Country | US
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Telephone | 973-763-2320
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Fax | 973-763-4648
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL G. QUILLEN
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Credential | M.D.
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Telephone | 973-763-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA34002
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License Number State | NJ
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