Healthcare Provider Details

I. General information

NPI: 1982244455
Provider Name (Legal Business Name): JAMES E VERGE BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 QUINEBAUG AVE
PUTNAM CT
06260-1943
US

IV. Provider business mailing address

62 BAILEY RD
MOOSUP CT
06354-2500
US

V. Phone/Fax

Practice location:
  • Phone: 860-315-9656
  • Fax: 860-315-9635
Mailing address:
  • Phone: 860-576-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: