Provider Demographics
NPI:1073300612
Name:VASQUEZ, JEFFREY MIGUEL SR
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MIGUEL
Last Name:VASQUEZ
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-2359
Mailing Address - Country:US
Mailing Address - Phone:862-378-1486
Mailing Address - Fax:
Practice Address - Street 1:271 19TH AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-2359
Practice Address - Country:US
Practice Address - Phone:862-378-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA007158171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter