MEDICARE: DR. JOSEFINA S. VELASQUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	140584	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005123	OTHER	NY	GHI

General Provider Information

NPI Number	:	1275740656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEFINA S. VELASQUEZ M.D.

Provider Business Mailing Address
First Line	:	1217 80TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2711
Country	:	US
Telephone Number	:	718-748-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1207
Country	:	US
Telephone Number	:	718-436-4781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	09/24/2014

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