Provider Demographics
NPI:1528406253
Name:VIGO, CARMEN V
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:V
Last Name:VIGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ESPLANADE AVE
Mailing Address - Street 2:2-H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1227
Mailing Address - Country:US
Mailing Address - Phone:646-410-1198
Mailing Address - Fax:
Practice Address - Street 1:1025 ESPLANADE AVE
Practice Address - Street 2:2-H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1227
Practice Address - Country:US
Practice Address - Phone:646-410-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist