Healthcare Provider Details

I. General information

NPI: 1366780728
Provider Name (Legal Business Name): MICHELLE JULIAN VAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2013
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7477
  • Fax:
Mailing address:
  • Phone: 718-579-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number281498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: