Provider Demographics
NPI:1902804479
Name:QUARTELLO, GARY LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LAWRENCE
Last Name:QUARTELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 SPRINGFIELD AVE
Mailing Address - Street 2:PO BOX 97
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1170
Mailing Address - Country:US
Mailing Address - Phone:908-665-2772
Mailing Address - Fax:908-665-0842
Practice Address - Street 1:369 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1170
Practice Address - Country:US
Practice Address - Phone:908-665-2772
Practice Address - Fax:908-665-0842
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00140100213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ15852OtherMASTERCARE
NJ2092808Medicaid
NJ1040011-027OtherCIGNA
NJ480024315OtherRAILROADMEDICARE
NJOK8635OtherFIRST OPTION
NJNEIC#23342OtherQUALCARE
NJUP155OtherOXFORD
NJ03000-1401NJ01OtherANTHEM HEALTH
NJ22313390-01OtherPRUDENTIAL
NJOK8635OtherFIRST OPTION
NJT45521Medicare UPIN