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General NPI Number Information
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NPI Number | 1326572637
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Entity Type | Individual
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Provider Name | CARLOS A VACA MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1 CAPITAL WAY
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City | PENNINGTON
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State | NJ
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Zip | 08534-2520
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Country | US
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Telephone | 609-303-4010
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Fax | 609-537-6168
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Provider Business Mailing Address
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Address Line | 788 COLUMBUS AVE APT 7K
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City | NEW YORK
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State | NY
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Zip | 10025-5929
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Country | US
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Telephone | 917-330-5484
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA11278900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 13437
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 312699
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License Number State | NY
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