MEDICARE: LUIS ENRIQUE VAZQUEZ FALCON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	07945600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D08758200	OTHER	NJ	CDS

General Provider Information

NPI Number	:	1134132871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ENRIQUE VAZQUEZ FALCON MD

Provider Business Mailing Address
First Line	:	7225 BERGENLINE AVE
Second Line	:	FIRST FLOOR
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5497
Country	:	US
Telephone Number	:	201-758-8012
Fax Number	:	201-758-8013

Provider Business Practice Location Address
First Line	:	7225 BERGENLINE AVE
Second Line	:	FIRST FLOOR
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5497
Country	:	US
Telephone Number	:	201-758-8012
Fax Number	:	201-758-8012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/07/2023

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