Organization
QUENTIN MEDICAL LAB
Active
Organization
QUENTIN MEDICAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PRENDIMANO (VICE PRESIDENT OF OPERATIONS)
(718) 492-2600
Entity
Organization
Contact information
Practice address
140 58TH ST, STE 1E, BROOKLYN, NY 11220-2562
(718) 492-2600
Mailing address
140 58TH ST, STE 1E, BROOKLYN, NY 11220-2562
(718) 492-2600
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
33D0147515
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000099801
AMERICHOICE
NY
05
—
01794774
—
NY
01
—
10200466
AMERIGROUP
NY
01
—
N240153
WELLCARE
NY
01
—
NY3961
HEALTHNET
NY
Enumeration date
05/31/2005
Last updated
09/08/2008
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