Basic Information
| Provider Information | |||||||||
| NPI: | 1093774804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELINOV | ||||||||
| FirstName: | MILEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 829642 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191829642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664706626 | ||||||||
| FaxNumber: | 4135990470 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 FRENCH ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322359386 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 238087 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 207SG0201X | 238087 | NY | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 207SG0201X | 25MA11058100 | NJ | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
ID Information
| ID | Type | State | Issuer | Description | 02554649 | 05 | NY | MEDICAID | 2554649 | 05 | NY | MEDICAID | P3641517 | 01 | OXFORD | OTHER | 7734837 | 01 | AETNA | OTHER | 113538 | 01 | GHI | OTHER | 1678160 | 01 | CIGNA | OTHER | 236635 | 01 | UNITED HEALTHCARE | OTHER | 000188480201 | 01 | HEALTHPLUS | OTHER | 223810P | 01 | HIP | OTHER | 5C4677 | 01 | HEALTHNET | OTHER | 6B8931 | 01 | EMPIRE BCBS | OTHER |