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General NPI Number Information
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NPI Number | 1649436155
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Entity Type | Individual
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Provider Name | OMAR CORUJO VAZQUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 30 7TH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 787-598-0225
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E 83RD STREET APT 7J APT 7J
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City | NEW YORK
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State | NY
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Zip | 10028
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Country | US
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Telephone | 787-598-0224
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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 | 12047 I
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License Number State | PR
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