Provider Demographics
NPI:1275854747
Name:SOARES-VELEZ, JAVIER IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:IGNACIO
Last Name:SOARES-VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 SHREWSBURY AVE
Mailing Address - Street 2:BLDG 1, SUITE 103
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3080
Mailing Address - Country:US
Mailing Address - Phone:787-557-6061
Mailing Address - Fax:
Practice Address - Street 1:788 SHREWSBURY AVE
Practice Address - Street 2:BLDG 1, SUITE 103
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3080
Practice Address - Country:US
Practice Address - Phone:787-557-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR18774208100000X
NJ25MA09751500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program