Provider Demographics
NPI:1124174396
Name:VAZQUEZ, PAUL HENRY (MS, PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:457 CLAY PITTS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3821
Mailing Address - Country:US
Mailing Address - Phone:631-486-8572
Mailing Address - Fax:631-368-4975
Practice Address - Street 1:457 CLAY PITTS RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3821
Practice Address - Country:US
Practice Address - Phone:631-486-8572
Practice Address - Fax:631-368-4975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018893-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics