Healthcare Provider Details

I. General information

NPI: 1104218254
Provider Name (Legal Business Name): NANCY VILBRUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 E 83RD ST FLOOR 1
BROOKLYN NY
11236-4704
US

IV. Provider business mailing address

1170 E 83RD STREEET FLOOR 1
BROOKLYN NY
11236
US

V. Phone/Fax

Practice location:
  • Phone: 347-486-2572
  • Fax:
Mailing address:
  • Phone: 347-486-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091773
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: