Individual
DR. MAURICIO VELASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6500 BROADWAY, WEST NEW YORK, NJ 07093-3112
(201) 864-3456
(201) 869-7224
Mailing address
6500 BROADWAY, WEST NEW YORK, NJ 07093-3112
(201) 864-3456
(201) 869-7224
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2342401
NY
207R00000X
Internal Medicine Physician
Primary
25MA07598200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060437
—
NJ
Enumeration date
11/18/2005
Last updated
10/13/2010
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