Provider Demographics
NPI:1174963581
Name:QUANTUM HEALTH SPA
Entity type:Organization
Organization Name:QUANTUM HEALTH SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-955-4550
Mailing Address - Street 1:15 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1400
Mailing Address - Country:US
Mailing Address - Phone:908-730-7366
Mailing Address - Fax:908-730-7366
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1400
Practice Address - Country:US
Practice Address - Phone:908-730-7366
Practice Address - Fax:908-730-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service