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General NPI Number Information
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NPI Number | 1619836640
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Entity Type | Individual
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Provider Name | TEOFILO ISAUL VASQUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 11515 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11434-1020
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Country | US
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Telephone | 929-473-9415
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Fax |
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Provider Business Mailing Address
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Address Line | 17 JOHNSON DR
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City | BRIGHTWATERS
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State | NY
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Zip | 11718-1404
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Country | US
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Telephone | 631-398-9986
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F312501-01
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License Number State | NY
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