Healthcare Provider Details

I. General information

NPI: 1720560741
Provider Name (Legal Business Name): DR VEZZA MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 E TREMONT AVE STE 100
BRONX NY
10465-2032
US

IV. Provider business mailing address

885 3RD AVE FL 28
NEW YORK NY
10022-4834
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-6621
  • Fax: 516-430-5031
Mailing address:
  • Phone: 212-734-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number169234
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number169234
License Number StateNY

VIII. Authorized Official

Name: ELANA LORRAINE VEZZA
Title or Position: OWNER
Credential: MD
Phone: 212-734-6621