Healthcare Provider Details

I. General information

NPI: 1790761120
Provider Name (Legal Business Name): THOMAS JOHN VAZZANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE SUITE 200
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

501 SEAVIEW AVE
STATEN ISLAND NY
10305-3419
US

V. Phone/Fax

Practice location:
  • Phone: 718-663-6400
  • Fax: 718-663-6490
Mailing address:
  • Phone: 718-663-6400
  • Fax: 718-663-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number178326
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number178326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: