MEDICARE: SAMUEL VAZQUEZ

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	225200000X	Physical Therapy Assistant	015364	NY

General Provider Information

NPI Number	:	1710818182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL VAZQUEZ

Provider Business Mailing Address
First Line	:	475 NORTHERN BLVD STE 37
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-4802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W 93RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7391
Country	:	US
Telephone Number	:	212-580-0125
Fax Number	:	516-466-7723

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ SAMUEL VAZQUEZ ” Practice Location

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