Provider Demographics
NPI:1194774232
Name:VAZQUEZ-CASALS, GONZALO ALBERTO (PHD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:ALBERTO
Last Name:VAZQUEZ-CASALS
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:BRAIN INJURY UNIT
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-1739
Mailing Address - Fax:516-674-1711
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:BRAIN INJURY UNIT
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2254
Practice Address - Country:US
Practice Address - Phone:516-674-1739
Practice Address - Fax:516-674-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2015-01-28
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Provider Licenses
StateLicense IDTaxonomies
NY0159541103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN1051Medicare ID - Type Unspecified