Healthcare Provider Details

I. General information

NPI: 1932198405
Provider Name (Legal Business Name): GEORGE W VELIKY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ROUTE 1 S BLDG A
ISELIN NJ
08830-3009
US

IV. Provider business mailing address

485 ROUTE 1 BLDG A
ISELIN NJ
08830-3009
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-0400
  • Fax: 732-750-1507
Mailing address:
  • Phone: 732-750-0400
  • Fax: 732-750-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00561500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: