Basic Information
| Provider Information | |||||||||
| NPI: | 1710051909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELASCO | ||||||||
| FirstName: | ALBERTO | ||||||||
| MiddleName: | NICANDRO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 HARDWOOD DR | ||||||||
| Address2: | |||||||||
| City: | TAPPAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109831100 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | DEPT. OF ANESTHESIOLOGY, 2B1 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795717 | ||||||||
| FaxNumber: | 7185795027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 166344-1 | NY | Y | Other Service Providers | Specialist |
No ID Information.