Healthcare Provider Details

I. General information

NPI: 1053519702
Provider Name (Legal Business Name): ANTONIO QUIACHON VELASCO JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

IV. Provider business mailing address

163 BRIDGETON PIKE
MULLICA HILL NJ
08062-2669
US

V. Phone/Fax

Practice location:
  • Phone: 856-508-1000
  • Fax:
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-221-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB08310600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB08310600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: