Healthcare Provider Details

I. General information

NPI: 1407299308
Provider Name (Legal Business Name): GINA VASQUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 LINDEN BLVD
BROOKLYN NY
11208-5126
US

IV. Provider business mailing address

14137 253RD ST
ROSEDALE NY
11422-2613
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-3100
  • Fax: 718-277-0822
Mailing address:
  • Phone: 516-205-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: