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General NPI Number Information
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NPI Number | 1336290402
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Entity Type | Individual
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Provider Name | MELVIN R VELAZQUEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 6907 43RD AVE SUITEC1
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City | WOODSIDE
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State | NY
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Zip | 11377-9100
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Country | US
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Telephone | 718-898-6010
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Fax | 718-606-2713
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Provider Business Mailing Address
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Address Line | 6 OLD SEARINGTOWN RD
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City | ALBERTSON
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State | NY
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Zip | 11507-1533
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Country | US
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Telephone | 516-742-3111
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Fax | 718-898-7473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 04513
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License Number State | NY
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