Provider Demographics
NPI:1689057671
Name:VEGA, ANYIRIS
Entity Type:Individual
Prefix:
First Name:ANYIRIS
Middle Name:
Last Name:VEGA
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 1:1516 OHM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1112
Mailing Address - Country:US
Mailing Address - Phone:646-548-7274
Mailing Address - Fax:
Practice Address - Street 1:4 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1222
Practice Address - Country:US
Practice Address - Phone:914-663-7070
Practice Address - Fax:914-663-7075
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator