Provider Demographics
NPI:1144510751
Name:QUIJANO, KENNETH (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:QUIJANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1243
Mailing Address - Country:US
Mailing Address - Phone:908-497-3925
Mailing Address - Fax:908-497-3989
Practice Address - Street 1:108 ALDEN ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2131
Practice Address - Country:US
Practice Address - Phone:908-497-3925
Practice Address - Fax:908-497-3989
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health