Provider Demographics
NPI:1093970204
Name:VASQUEZ, BETZAIDA (CNIM)
Entity Type:Individual
Prefix:MISS
First Name:BETZAIDA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3957
Mailing Address - Country:US
Mailing Address - Phone:201-327-8600
Mailing Address - Fax:201-327-8225
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-327-8600
Practice Address - Fax:201-327-8225
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1452246ZE0500X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG