Individual
MISS CORAL ELISE QUINTYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3240 201ST ST, BAYSIDE, NY 11361-1016
(718) 428-6179
Mailing address
1225 EASTERN PKWY, BROOKLYN, NY 11213-4189
(347) 350-3996
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
00293012
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112689787
—
NY
Enumeration date
11/20/2008
Last updated
11/20/2008
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