Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2914 | NY |
NPI | 1679903686 |
---|---|
Provider Name | Dr. Juan Velez |
First Address | Mamaroneck, NY 10543-1237 |
Second Address | Mamaroneck, NY 10543-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 10/11/2015 |