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General NPI Number Information
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NPI Number | 1316034820
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Entity Type | Individual
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Provider Name | EDGAR Z VANEGAS MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 8505 167TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-2621
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Country | US
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Telephone | 718-658-7482
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Fax | 718-658-7531
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Provider Business Mailing Address
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Address Line | 8505 167TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-2621
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Country | US
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Telephone | 718-658-7482
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Fax | 718-658-7531
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 190283-1
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License Number State | NY
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