Healthcare Provider Details

I. General information

NPI: 1508731456
Provider Name (Legal Business Name): DENISE VASQUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE REDFERN

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/24/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FERN PL
PLAINVIEW NY
11803-4725
US

IV. Provider business mailing address

355 ROUTE 111 UNIT 31
SMITHTOWN NY
11787-4747
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: