Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 25MB08310600 | NJ |
N | 207RP1001X | Pulmonary Disease | 25MB08310600 | NJ |
NPI | 1053519702 |
---|---|
Provider Name | Dr. Antonio Quiachon Velasco JR. |
First Address | Marlton, NJ 08053-4197 |
Second Address | Cherry Hill, NJ 08034-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 20/10/2020 |