Provider Demographics
NPI:1740664515
Name:GONZALEZ VELEZ, MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:GONZALEZ VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 1ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2190
Mailing Address - Country:US
Mailing Address - Phone:551-996-2098
Mailing Address - Fax:551-996-8198
Practice Address - Street 1:92 2ND ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2191
Practice Address - Country:US
Practice Address - Phone:551-996-5900
Practice Address - Fax:201-662-1267
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MS12297100207RH0003X
390200000X
AZ56613207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program