Provider Demographics
NPI:1427574912
Name:VASQUEZ-CARDENAS, FELIPE (OTR)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
Last Name:VASQUEZ-CARDENAS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 MIDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5519
Mailing Address - Country:US
Mailing Address - Phone:551-265-7646
Mailing Address - Fax:
Practice Address - Street 1:566 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1333
Practice Address - Country:US
Practice Address - Phone:201-543-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist