Provider Demographics
NPI:1134132871
Name:VAZQUEZ FALCON, LUIS ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:VAZQUEZ FALCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 BERGENLINE AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5497
Mailing Address - Country:US
Mailing Address - Phone:201-758-8012
Mailing Address - Fax:201-758-8013
Practice Address - Street 1:7225 BERGENLINE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5497
Practice Address - Country:US
Practice Address - Phone:201-758-8012
Practice Address - Fax:201-758-8012
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ07945600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08758200OtherCDS
NJD08758200OtherCDS
NJBV9424108OtherDEA
097277BPXMedicare ID - Type Unspecified