Provider Demographics
NPI:1962402156
Name:VELEZ, GILBERTO A (MD)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:A
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GILBERTO
Other - Middle Name:ANGEL
Other - Last Name:VELEZ-DOMENECH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:503 GRASSLANDS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1503
Mailing Address - Country:US
Mailing Address - Phone:914-304-5288
Mailing Address - Fax:914-345-1755
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7494
Practice Address - Country:US
Practice Address - Phone:212-423-6313
Practice Address - Fax:212-423-7697
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1325102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00319282Medicaid
NY519101Medicare PIN
NY00319282Medicaid