Provider Demographics
NPI:1760657910
Name:E. CHARLES VELNOSKY PHD PA
Entity Type:Organization
Organization Name:E. CHARLES VELNOSKY PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:VELNOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-653-8490
Mailing Address - Street 1:19 YALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1335
Mailing Address - Country:US
Mailing Address - Phone:609-653-8490
Mailing Address - Fax:609-927-5755
Practice Address - Street 1:19 YALE BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1335
Practice Address - Country:US
Practice Address - Phone:609-653-8490
Practice Address - Fax:609-927-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00153700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162206000OtherMAGELLAN
NJ162206000OtherMAGELLAN
NJ=========OtherTRICARE
NJVE438343Medicare PIN