Provider Demographics
NPI:1104800333
Name:VELOSO, CESAR V (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:V
Last Name:VELOSO
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 1:532 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5422
Mailing Address - Country:US
Mailing Address - Phone:201-445-0527
Mailing Address - Fax:718-624-3424
Practice Address - Street 1:301 HOYT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4907
Practice Address - Country:US
Practice Address - Phone:718-624-3424
Practice Address - Fax:718-624-4566
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114830207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00210453Medicaid
NY00210453Medicaid