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General NPI Number Information
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NPI Number | 1811436736
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Entity Type | Individual
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Provider Name | TRISTAN VIZCONDE
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 10524 63RD DR APT 1J
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City | FOREST HILLS
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State | NY
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Zip | 11375-1636
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Country | US
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Telephone | 646-643-0796
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Fax | 646-328-9323
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Provider Business Mailing Address
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Address Line | 1080 OLD COUNTRY RD # 1053
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City | WESTBURY
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State | NY
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Zip | 11590-5625
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Country | US
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Telephone | 646-801-7615
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Fax | 646-328-9323
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 092928-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 090700
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License Number State | NY
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