Provider Demographics
NPI:1366049355
Name:VAZQUEZ, GABRIELLA (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26912 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1535
Mailing Address - Country:US
Mailing Address - Phone:917-200-4490
Mailing Address - Fax:
Practice Address - Street 1:26912 UNION TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1535
Practice Address - Country:US
Practice Address - Phone:917-200-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant