Provider Demographics
NPI:1053472654
Name:LAMOTTE VELEZ, ELVIS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:ELVIS
Middle Name:
Last Name:LAMOTTE VELEZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 KENNEDY BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5590
Mailing Address - Country:US
Mailing Address - Phone:201-974-1433
Mailing Address - Fax:206-974-1437
Practice Address - Street 1:4914 KENNEDY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5590
Practice Address - Country:US
Practice Address - Phone:201-974-1433
Practice Address - Fax:206-974-1437
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00525200225100000X
NY0224901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064384Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NYQK6071Medicare PIN