MEDICARE: DR. LUIS ANTONIO VASQUEZ PAC

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	173000000X	Legal Medicine	009723-1	NY

General Provider Information

NPI Number	:	1760407084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ANTONIO VASQUEZ PAC

Provider Business Mailing Address
First Line	:	66 FORT WASHINGTON AVE
Second Line	:	FORT WASHINGTON MEDICALL OFFICE
City	:	NEW YORK
State	:	NY
Zip	:	10032-4711
Country	:	US
Telephone Number	:	212-927-0013
Fax Number	:	212-927-0014

Provider Business Practice Location Address
First Line	:	66 FORT WASHINGTON AVE
Second Line	:	FORT WASHINGTON MEDICALL OFFICE
City	:	NEW YORK
State	:	NY
Zip	:	10032-4711
Country	:	US
Telephone Number	:	212-927-0013
Fax Number	:	212-927-0014

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/08/2014

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