1821081746 NPI number — MS. KIM A VAZQUEZ CRNA

Table of content: MS. KIM A VAZQUEZ CRNA (NPI 1821081746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821081746 NPI number — MS. KIM A VAZQUEZ CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ
Provider First Name:
KIM
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANNON
Provider Other First Name:
KIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821081746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CATHARINE STREET, P.O. BOX 550
Provider Second Line Business Mailing Address:
EAST MANHATTAN ANESTHESIA PARTNERS, LLC
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-868-8415
Provider Business Mailing Address Fax Number:
845-790-2675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 E 14TH STREET
Provider Second Line Business Practice Location Address:
MY EYE & EAR INFIRMARY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-979-4464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  463192 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 463192-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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