Provider Demographics
NPI:1316046451
Name:VELA, ANTHONY T (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:VELA
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:PO BOX 540898
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-0898
Mailing Address - Country:US
Mailing Address - Phone:718-445-1482
Mailing Address - Fax:718-670-3161
Practice Address - Street 1:14601 45TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2200
Practice Address - Country:US
Practice Address - Phone:718-445-1482
Practice Address - Fax:718-670-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167822207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01646982Medicaid
NYE78970Medicare UPIN
NY50652Medicare ID - Type Unspecified