Provider Demographics
NPI:1942570577
Name:MANUEL VELOSO PC
Entity Type:Organization
Organization Name:MANUEL VELOSO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELOSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:516-431-2828
Mailing Address - Street 1:303 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3600
Mailing Address - Country:US
Mailing Address - Phone:516-431-2828
Mailing Address - Fax:516-431-3747
Practice Address - Street 1:303 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3600
Practice Address - Country:US
Practice Address - Phone:516-431-2828
Practice Address - Fax:516-431-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111634261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMV0578621Medicare PIN
NYB78033Medicare UPIN