MEDICARE: GEORGE VELASCO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	325221	NY

General Provider Information

NPI Number	:	1740819671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE VELASCO MD

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PL # 1118
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2771 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3027
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	08/30/2023

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