Provider Demographics
NPI:1801188594
Name:VELASQUEZ, ELIEZER (COTA)
Entity Type:Individual
Prefix:MR
First Name:ELIEZER
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 35TH AVE
Mailing Address - Street 2:APT. 2B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3633
Mailing Address - Country:US
Mailing Address - Phone:718-961-7715
Mailing Address - Fax:
Practice Address - Street 1:1120 MORRIS PARK AVE. STE 2B
Practice Address - Street 2:THERAPEUTIC IMPRINTS, INC.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-409-6977
Practice Address - Fax:718-409-6946
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant