Healthcare Provider Details

I. General information

NPI: 1114842465
Provider Name (Legal Business Name): QUANTIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22210 93RD RD
QUEENS VILLAGE NY
11428-1936
US

IV. Provider business mailing address

22210 93RD RD
QUEENS VILLAGE NY
11428-1936
US

V. Phone/Fax

Practice location:
  • Phone: 34-639-6125
  • Fax:
Mailing address:
  • Phone: 346-396-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOVELY AKTER
Title or Position: OWNER
Credential:
Phone: 703-705-9285