Healthcare Provider Details

I. General information

NPI: 1033905005
Provider Name (Legal Business Name): FATBARDHA VATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3866 11TH ST
LONG ISLAND CITY NY
11101-6178
US

IV. Provider business mailing address

3866 11TH ST
LONG ISLAND CITY NY
11101-6178
US

V. Phone/Fax

Practice location:
  • Phone: 914-886-4571
  • Fax:
Mailing address:
  • Phone: 914-886-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number943890
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: