Active NPI
Nerissa K Velazco, MD
- Pediatrics Physician
- Bronx, NY
National Provider Identifier
1144684028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 305401
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (718) 741-2332
- NPI assigned
- Apr 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 305401 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
585 North Ave Apt 417
New Rochelle, NY 10801-2654
Phone (516) 476-9315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190314002225 | NY | Order and Referring Only - Pediatric Medicine | 7911247788 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305401 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1144684028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "585 NORTH AVE APT 417",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "108012654",
"telephone_number": "516-476-9315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "718-741-2332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELAZCO",
"first_name": "NERISSA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-07",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "305401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.