Provider Demographics
NPI:1114934874
Name:VELAZQUEZ, JOSEPHINE (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:JOSEPHINE
Other - Middle Name:V
Other - Last Name:RUCQUOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 OLD KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4521
Mailing Address - Country:US
Mailing Address - Phone:203-655-6299
Mailing Address - Fax:203-656-2607
Practice Address - Street 1:20 OLD KINGS HWY S
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4521
Practice Address - Country:US
Practice Address - Phone:203-655-6299
Practice Address - Fax:203-656-2607
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000670213ES0000X
NYN004823213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTRS178OtherOXFORD INSURANCE ID #
CTRS178OtherOXFORD INSURANCE ID #
CT48000703Medicare ID - Type UnspecifiedMEDICARE ID #