Healthcare Provider Details

I. General information

NPI: 1518039254
Provider Name (Legal Business Name): MANUEL VELAZQUEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E HOUSTON ST
NEW YORK NY
10002-1034
US

IV. Provider business mailing address

200 E 61ST ST APT 5G
NEW YORK NY
10021-8550
US

V. Phone/Fax

Practice location:
  • Phone: 212-353-8314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number178765
License Number StateNM

VIII. Authorized Official

Name: MANUEL VELAZQUEZ
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 718-302-1800