Provider Demographics
NPI:1275740656
Name:VELASQUEZ, JOSEFINA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:S
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2711
Mailing Address - Country:US
Mailing Address - Phone:718-748-1878
Mailing Address - Fax:
Practice Address - Street 1:4609 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1207
Practice Address - Country:US
Practice Address - Phone:718-436-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140584207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005123OtherGHI
NY0005123OtherGHI
NYC02567Medicare UPIN