Healthcare Provider Details

I. General information

NPI: 1750554705
Provider Name (Legal Business Name): MIODRAG VELICKOVIC, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 11/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 COMMERCE ST #107
YORKTOWN HEIGHTS NY
10598-4428
US

IV. Provider business mailing address

1940 COMMERCE ST #107
YORKTOWN HEIGHTS NY
10598-4428
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-1000
  • Fax: 914-962-8267
Mailing address:
  • Phone: 914-962-1000
  • Fax: 914-962-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number222598
License Number StateNY

VIII. Authorized Official

Name: DR. MIODRAG VELICKOVIC
Title or Position: PRESIDENT
Credential:
Phone: 914-962-1000