=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568304152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN ORLANDO VELAZQUEZ CUCURULLO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ST ANDREWS LN NORTHWELL HEALTH - GLEN COVE HOSPITAL
-----------------------------------------------------
City | GLEN COVE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-717-4629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ST ANDREWS LN GLEN COVE HOSPITAL
-----------------------------------------------------
City | GLEN COVE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-717-4629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------