MEDICARE: IRWIN VARGAS-DE LEON

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	174400000X	Specialist	1498314211	NY

General Provider Information

NPI Number	:	1255009916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRWIN VARGAS-DE LEON

Provider Business Mailing Address
First Line	:	620 W 189TH ST APT 3E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-4224
Country	:	US
Telephone Number	:	484-219-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 W 189TH ST APT 3E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-4224
Country	:	US
Telephone Number	:	484-219-8664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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Directions to “ IRWIN VARGAS-DE LEON ” Practice Location

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