Healthcare Provider Details

I. General information

NPI: 1639454952
Provider Name (Legal Business Name): YVETTE MARIA VASQUEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 59TH ST
NEW YORK NY
10022-1202
US

IV. Provider business mailing address

111 E 59TH ST
NEW YORK NY
10022-1202
US

V. Phone/Fax

Practice location:
  • Phone: 212-821-9200
  • Fax:
Mailing address:
  • Phone: 212-821-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number697300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: