Provider Demographics
NPI:1437029865
Name:VASQUEZ, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SCHLEY ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2027
Mailing Address - Country:US
Mailing Address - Phone:973-214-7248
Mailing Address - Fax:
Practice Address - Street 1:141 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4018
Practice Address - Country:US
Practice Address - Phone:973-657-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist