Provider Demographics
NPI:1780950477
Name:VELLA, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:VELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 FOREST AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 W 134TH ST
Practice Address - Street 2:ROOM 115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-3002
Practice Address - Country:US
Practice Address - Phone:212-690-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist