Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 272256 | NY |
Y | 207Q00000X | Family Doctor | 53485 | CT |
N | 207QS0010X | Family Doctor - Sports Medicine | 272256 | NY |
NPI | 1164867347 |
---|---|
Provider Name | Romulo V Vasquez |
First Address | Fairfield, CT 06825-5508 |
Second Address | Fairfield, CT 06825-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 10/06/2021 |