1558519678 NPI number — DR. LARA VALENTINE QUATINETZ D.O.

Table of content: DR. LARA VALENTINE QUATINETZ D.O. (NPI 1558519678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558519678 NPI number — DR. LARA VALENTINE QUATINETZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUATINETZ
Provider First Name:
LARA
Provider Middle Name:
VALENTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558519678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CROSS RIVER ROAD
Provider Second Line Business Mailing Address:
FOUR WINDS HOSPITAL
Provider Business Mailing Address City Name:
KATONAH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-763-8151
Provider Business Mailing Address Fax Number:
877-810-1175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CROSS RIVER ROAD
Provider Second Line Business Practice Location Address:
FOUR WINDS HOSPITAL
Provider Business Practice Location Address City Name:
KATONAH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-763-8151
Provider Business Practice Location Address Fax Number:
877-810-1175
Provider Enumeration Date:
09/03/2008

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: 2084P0804X , with the licence number:  265959 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 265959 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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