=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083977623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRENE BALBINA VAZQUEZ MS SPEC ED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2012
-----------------------------------------------------
Last Update Date | 06/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 LIVINGSTON ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-5078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-625-4055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 886
-----------------------------------------------------
City | FLEISCHMANNS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12430-0886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-921-4003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | SPEC EDUCATION
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------