Provider Demographics
NPI:1407118771
Name:VELASQUEZ, ENA E (MSED)
Entity Type:Individual
Prefix:MS
First Name:ENA
Middle Name:E
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5805
Mailing Address - Country:US
Mailing Address - Phone:347-653-4623
Mailing Address - Fax:
Practice Address - Street 1:1879 HENRY ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5805
Practice Address - Country:US
Practice Address - Phone:347-653-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist