Individual
MR. MARK PHILIP VELAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 ORMAND AVE, MEDFORD, NY 11763-4412
(631) 834-1208
Mailing address
11 ORMAND AVE, MEDFORD, NY 11763-4412
(631) 834-1208
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
251300000X
Local Education Agency (LEA)
Primary
—
NY
Other
Enumeration date
01/29/2007
Last updated
03/09/2020
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