Healthcare Provider Details

I. General information

NPI: 1194521021
Provider Name (Legal Business Name): SARETTA ISIDORE VAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E 84TH ST
NEW YORK NY
10028-2973
US

IV. Provider business mailing address

31 E 32ND ST FL 4
NEW YORK NY
10016-5595
US

V. Phone/Fax

Practice location:
  • Phone: 646-841-1414
  • Fax: 212-379-2122
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: