| Doctor Name: | MR. KENNETH QUIJANO |
| NPI Number: | 1144510751 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 108 Alden St Cranford, NJ - 070162131 |
| Business Phone Number: | 9084973925 |
| Business Fax Number: | 9084973989 |
| Mailing Address: | 225 N 16th St, KENILWORTH |
| State: | NJ |
| Postal Code: | 070331243 |
| Phone Number: | 9084973925 |
| Fax Number: | 9084973989 |
| NPI Enumeration Date: | 04/15/2011 |
| NPI Last Update Date: | 09/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |