Healthcare Provider Details

I. General information

NPI: 1255640181
Provider Name (Legal Business Name): MARIA- ANNA VASTARDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9036 7TH AVE
BROOKLYN NY
11228-3625
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 50
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-1403
  • Fax:
Mailing address:
  • Phone: 718-270-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number254944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: