MEDICARE: DR. DANTE BERMUNDO QUIAMBAO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MA63400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437121266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANTE BERMUNDO QUIAMBAO MD

Provider Business Mailing Address
First Line	:	1200 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3324
Country	:	US
Telephone Number	:	732-797-3890
Fax Number	:	732-797-3893

Provider Business Practice Location Address
First Line	:	54 BEY LEA RD
Second Line	:	BLDG 2
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2891
Country	:	US
Telephone Number	:	732-281-1020
Fax Number	:	732-797-3893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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