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NPI Code Detail

MEDICARE: TEOFILO ISAUL VASQUEZ

MEDICARE: TEOFILO ISAUL VASQUEZ
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
1363LA2200XAdult Health Nurse PractitionerF312501-01NY

General Provider Information

NPI Number : 1619836640
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEOFILO ISAUL VASQUEZ
Provider Business Mailing Address
First Line : 17 JOHNSON DR
Second Line :
City : BRIGHTWATERS
State : NY
Zip : 11718-1404
Country : US
Telephone Number : 631-398-9986
Fax Number :
Provider Business Practice Location Address
First Line : 11515 SUTPHIN BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11434-1020
Country : US
Telephone Number : 929-473-9415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “ TEOFILO ISAUL VASQUEZ ” Practice Location

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