Healthcare Provider Details

I. General information

NPI: 1497685028
Provider Name (Legal Business Name): VILIAN QUACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 PRINCE ST STE 3C
FLUSHING NY
11354-4650
US

IV. Provider business mailing address

2510 COLLEGE POINT BLVD
FLUSHING NY
11354-1045
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-7800
  • Fax:
Mailing address:
  • Phone: 646-266-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358785-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: