Healthcare Provider Details

I. General information

NPI: 1356760631
Provider Name (Legal Business Name): ELIZABETH VERRICO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 405
ENGLEWOOD NJ
07631-4960
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-1811
  • Fax: 201-616-7789
Mailing address:
  • Phone: 201-225-1811
  • Fax: 201-616-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberOS022028
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MB11540300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: