Provider Demographics
NPI:1326049909
Name:ABASCAL, VIVIAN M (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:ABASCAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117-10 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419
Mailing Address - Country:US
Mailing Address - Phone:718-297-0440
Mailing Address - Fax:718-297-0442
Practice Address - Street 1:117-10 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-297-0440
Practice Address - Fax:718-297-0442
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239842207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02444833Medicaid