Provider Demographics
NPI:1518087634
Name:WASHINGTON HEIGHTS MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:WASHINGTON HEIGHTS MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-928-5959
Mailing Address - Street 1:130 WADSWORTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4814
Mailing Address - Country:US
Mailing Address - Phone:212-928-5959
Mailing Address - Fax:212-928-5189
Practice Address - Street 1:130 WADSWORTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4814
Practice Address - Country:US
Practice Address - Phone:212-928-5959
Practice Address - Fax:212-928-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166974174400000X
207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01855283Medicaid
NY00984203Medicaid
NY81D421Medicare PIN
NYF93106Medicare UPIN
NY00984203Medicaid
NY01855283Medicaid