Provider Demographics
NPI:1720560741
Name:DR VEZZA MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:DR VEZZA MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELANA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:VEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-408-8860
Mailing Address - Street 1:670 MYRTLE AVE STE 198
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3923
Mailing Address - Country:US
Mailing Address - Phone:718-408-8860
Mailing Address - Fax:
Practice Address - Street 1:3594 E TREMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2032
Practice Address - Country:US
Practice Address - Phone:718-408-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169234207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty