MEDICARE: DR. IVAN VELICKOVIC 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	207L00000X	Anesthesiology Physician	249250	NY

General Provider Information

NPI Number	:	1891789160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN VELICKOVIC M.D.

Provider Business Mailing Address
First Line	:	333 CEDAR ST DEPT OF
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-3325
Fax Number	:	718-245-3054

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	05/13/2025

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