Healthcare Provider Details

I. General information

NPI: 1003907627
Provider Name (Legal Business Name): VICTOR T VERLEZZA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE SUITE 307
EAST ORANGE NJ
07018-2835
US

IV. Provider business mailing address

310 CENTRAL AVE SUITE 307
EAST ORANGE NJ
07018-2835
US

V. Phone/Fax

Practice location:
  • Phone: 973-266-7860
  • Fax: 201-266-7861
Mailing address:
  • Phone: 973-266-7860
  • Fax: 201-266-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00481700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: