Basic Information
| Provider Information | |||||||||
| NPI: | 1326049909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABASCAL | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117-10 HILLSIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182970440 | ||||||||
| FaxNumber: | 7182970442 | ||||||||
| Practice Location | |||||||||
| Address1: | 117-10 HILLSIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182970440 | ||||||||
| FaxNumber: | 7182970442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 239842 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 02444833 | 05 | NY | MEDICAID |