MEDICARE: QUORUM VITALS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1205497955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUORUM VITALS INC

Provider Business Mailing Address
First Line	:	12 PITCHER WAY
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-5298
Country	:	US
Telephone Number	:	516-451-0367
Fax Number	:

Provider Business Practice Location Address
First Line	:	16410 NORTHERN BLVD STE 206
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-321-2940
Fax Number	:	718-321-2942

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETRONELA ANTOHI
Credential	:	MD
Telephone Number	:	516-451-0367

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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Directions to “QUORUM VITALS INC ” Practice Location

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