Healthcare Provider Details

I. General information

NPI: 1033174909
Provider Name (Legal Business Name): ALICE VELOUDIOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY JAMAICA ANESTHESIA ASSOCIATES PC
JAMAICA NY
11418
US

IV. Provider business mailing address

80 MARCUS DR
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6039
  • Fax: 718-206-6145
Mailing address:
  • Phone: 631-391-8354
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number195872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: