Provider Demographics
NPI:1013014521
Name:VELASCO, SONIA CASTANEDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:CASTANEDA
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SONIA
Other - Middle Name:ABELLA
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2727
Mailing Address - Country:US
Mailing Address - Phone:908-753-8458
Mailing Address - Fax:
Practice Address - Street 1:172 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-332-4727
Practice Address - Fax:201-332-4157
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02717800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1698401-01Medicaid
NJ1698401-01Medicaid
E70428Medicare UPIN