NPIMap

Individual provider Active NPI

Mauricio Velasco, M.D.

  • Internal Medicine Physician
  • West New York, NJ
National Provider Identifier
1508848979
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07598200 Issued in NJ
Practice address
6500 Broadway
West New York, NJ 07093-3112
Phone
(201) 864-3456
Fax
(201) 869-7224
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07598200 NJ Primary
Internal Medicine Physician 207R00000X 2342401 NY

Addresses

Primary practice location

6500 Broadway
West New York, NJ 07093-3112

Mailing address

6500 Broadway
West New York, NJ 07093-3112
Phone (201) 864-3456

Other identifiers 1

IdentifierTypeStateIssuer
0060437MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040623000013 NJ Practitioner - Internal Medicine 2961487988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Excelcare Medical Associates PAGroup PAC ID 4284647868, 200 clinicians

Practice addresses (Care Compare)

408 37TH St
Union City, NJ 07087-4994
Phone (201) 864-4477

6500 Broad Way
West New York, NJ 07093-3112
Phone (201) 864-3456

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Hackensack, NJ, CCN 317047
  • Promise Care NJ Home health agency, West New York, NJ, CCN 317064
  • Palisades Medical Center Hospital, North Bergen, NJ, CCN 310003
  • Englewood Hospital and Medical Center Hospital, Englewood, NJ, CCN 310045
  • Holy Name Medical Center Hospital, Teaneck, NJ, CCN 310008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2342401NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Excelcare Medical Associates, PA Internal Medicine CurrentSince Dec 1, 2015 Accepting new patients
Cardio-Med Services LLC Internal Medicine Past Accepting new patients
Comprehensive Healhtcare and Medical Services PLLC Internal Medicine Past Accepting new patients
New York Medical and Cardiovascular Services, PC Internal Medicine Past Accepting new patients
HMH Hospitals Corporation Past Accepting new patients

Locations

1 W Ridgewood Ave
Ste 203
Paramus, NJ 07652
Phone (201) 312-5243

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

3196 Kennedy Blvd
Ste 3
Union City, NJ 07087
Phone (201) 223-4949

6500 Broadway
West New York, NJ 07093
Phone (201) 864-3456

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1508848979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BROADWAY",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070933112",
            "telephone_number": "201-864-3456",
            "fax_number": "201-869-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 BROADWAY",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070933112",
            "telephone_number": "201-864-3456",
            "fax_number": "201-869-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASCO",
        "first_name": "MAURICIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07598200",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "2342401",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060437",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West New York, NJ

Sources for this page

Verify at the official NPI Registry.