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General NPI Number Information
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NPI Number | 1578634614
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Entity Type | Individual
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Provider Name | RAPHAEL LUIS VAZQUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 285 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10032-1206
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Country | US
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Telephone | 212-927-0060
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Fax | 212-923-3359
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Provider Business Mailing Address
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Address Line | 15 CORNELIA DR
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City | GREENWICH
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State | CT
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Zip | 06830-3906
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Country | US
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Telephone | 203-542-5184
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Fax | 203-542-5184
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 135505
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 135505
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License Number State | NY
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