Provider Demographics
NPI:1861443855
Name:VELOSO, CORAZON MORALES (MD)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:MORALES
Last Name:VELOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MEYERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1126
Mailing Address - Country:US
Mailing Address - Phone:973-635-7616
Mailing Address - Fax:201-863-2730
Practice Address - Street 1:714 31ST ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2427
Practice Address - Country:US
Practice Address - Phone:201-863-7077
Practice Address - Fax:201-863-2730
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5410606Medicaid
NJMA 57092OtherLICENSE NUMBER
NJ5410606Medicaid