Healthcare Provider Details

I. General information

NPI: 1740664515
Provider Name (Legal Business Name): MIGUEL GONZALEZ VELEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

100 1ST ST STE 301
HACKENSACK NJ
07601-2190
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5900
  • Fax: 201-662-1267
Mailing address:
  • Phone: 551-996-2098
  • Fax: 551-996-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MS12297100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: