Provider Demographics
NPI:1083977623
Name:VAZQUEZ, IRENE BALBINA (MS SPEC ED)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:BALBINA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:FLEISCHMANNS
Mailing Address - State:NY
Mailing Address - Zip Code:12430-0886
Mailing Address - Country:US
Mailing Address - Phone:917-921-4003
Mailing Address - Fax:
Practice Address - Street 1:111 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5078
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSPEC EDUCATION174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist