Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 018893-1 | NY |
NPI | 1124174396 |
---|---|
Provider Name | Paul Henry Vazquez |
First Address | East Northport, NY 11731-3821 |
Second Address | East Northport, NY 11731-3821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |