1164973590 NPI number — ELSY ESTELLA QUINTERO MS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164973590 NPI number — ELSY ESTELLA QUINTERO MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTERO
Provider First Name:
ELSY
Provider Middle Name:
ESTELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITNEY
Provider Other First Name:
ELSY
Provider Other Middle Name:
ESTELLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164973590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 SOUTH UNION STREET, SUITE 104 HERITAGE BUILDING 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-648-8515
Provider Business Mailing Address Fax Number:
339-440-4483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 WINTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-5760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-373-1181
Provider Business Practice Location Address Fax Number:
978-374-7605
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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