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General NPI Number Information
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NPI Number | 1306975404
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Entity Type | Individual
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Provider Name | VASTHY T JEAN-LOUIS DPM
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 455 FRANKLIN AVE
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City | BROOKLYN
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State | NY
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Zip | 11238-2605
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Country | US
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Telephone | 347-770-9900
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Fax | 718-819-1318
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Provider Business Mailing Address
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Address Line | 27 PATRICK ST
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City | CARTERET
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State | NJ
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Zip | 07008-1864
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Country | US
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Telephone | 973-342-6621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N006152
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00293100
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License Number State | NJ
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