Healthcare Provider Details

I. General information

NPI: 1164334751
Provider Name (Legal Business Name): MARIA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 15TH ST
UNION CITY NJ
07087-5993
US

IV. Provider business mailing address

421 15TH ST
UNION CITY NJ
07087-5993
US

V. Phone/Fax

Practice location:
  • Phone: 201-873-8611
  • Fax: 201-945-3549
Mailing address:
  • Phone: 201-873-8611
  • Fax: 201-945-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: