Basic Information
| Provider Information | |||||||||
| NPI: | 1518402890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6209 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112042702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182340073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6209 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112042702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182340073 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2016 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | 163WA0400X | 647833 | NY | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 163WA2000X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Administrator | 163WC0400X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Case Management | 163WC1600X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development | 163WC2100X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Continence Care | 163WD0400X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 163WE0003X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Emergency | 163WG0000X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | General Practice | 163WI0600X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Infection Control | 163WP0000X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Pain Management | 163WP0808X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 163WP2201X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Ambulatory Care | 163WW0000X | 647833 | NY | N | Nursing Service Providers | Registered Nurse | Wound Care |
No ID Information.