Healthcare Provider Details

I. General information

NPI: 1972743938
Provider Name (Legal Business Name): VELEKA WILLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

595 E 57TH ST
BROOKLYN NY
11234-1203
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number245426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: