Provider Demographics
NPI:1659359289
Name:VELIKY, MICHAEL J (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:VELIKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 ROUTE 1 SOUTH
Mailing Address - Street 2:BLDG A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:732-750-1507
Practice Address - Street 1:485 ROUTE 1 SOUTH
Practice Address - Street 2:BLDG A
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-750-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00520900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5287006Medicaid
NJ132619MP7Medicare ID - Type Unspecified
U35518Medicare UPIN