MEDICARE: CARL G. QUILLEN, M.D. P.A.

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	174400000X	Specialist	MA34002	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	:	1467492322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL G. QUILLEN, M.D. P.A.

Provider Business Mailing Address
First Line	:	2040 MILLBURN AVE
Second Line	:	SUITE 405
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3726
Country	:	US
Telephone Number	:	973-763-2320
Fax Number	:	973-763-4648

Provider Business Practice Location Address
First Line	:	2040 MILLBURN AVE
Second Line	:	SUITE 405
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3726
Country	:	US
Telephone Number	:	973-763-2320
Fax Number	:	973-763-4648

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARL G. QUILLEN
Credential	:	M.D.
Telephone Number	:	973-763-2320

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	10/05/2011

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