=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124927173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONER IN PSYCHIATRY SERVICES OF JOSE M. VAZQUEZ CRUZ, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1870 62ND ST APT 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-916-0420
-----------------------------------------------------
Fax | 718-232-2439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1870 62ND ST APT 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-916-0420
-----------------------------------------------------
Fax | 718-232-2439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | JOSE MANUEL VAZQUEZ CRUZ
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 929-216-5357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------