Provider Demographics
NPI:1750554705
Name:MIODRAG VELICKOVIC, M.D. P.C.
Entity type:Organization
Organization Name:MIODRAG VELICKOVIC, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIODRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:VELICKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-962-1000
Mailing Address - Street 1:1940 COMMERCE ST
Mailing Address - Street 2:#107
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4428
Mailing Address - Country:US
Mailing Address - Phone:914-962-1000
Mailing Address - Fax:914-962-8267
Practice Address - Street 1:1940 COMMERCE ST
Practice Address - Street 2:#107
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4428
Practice Address - Country:US
Practice Address - Phone:914-962-1000
Practice Address - Fax:914-962-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2225982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH47990Medicare UPIN
NY07Q133Medicare PIN