Healthcare Provider Details

I. General information

NPI: 1326952029
Provider Name (Legal Business Name): QUASIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 21ST AVE APT 2E
ASTORIA NY
11105-4233
US

IV. Provider business mailing address

1812 21ST AVE APT 2E
ASTORIA NY
11105-4233
US

V. Phone/Fax

Practice location:
  • Phone: 570-580-8580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1960985251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: