Provider Demographics
NPI:1043872237
Name:VELASQUEZ, NATHALIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NATHALIA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25510 IOWA RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1425
Mailing Address - Country:US
Mailing Address - Phone:516-946-7710
Mailing Address - Fax:
Practice Address - Street 1:25510 IOWA RD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1425
Practice Address - Country:US
Practice Address - Phone:516-946-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023576-01363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical