Healthcare Provider Details

I. General information

NPI: 1205898830
Provider Name (Legal Business Name): TRACY B VERRICO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 KINDERKAMACK RD
ORADELL NJ
07649-1519
US

IV. Provider business mailing address

88 HORIZON TER
HILLSDALE NJ
07642-1016
US

V. Phone/Fax

Practice location:
  • Phone: 551-278-5898
  • Fax: 551-236-1771
Mailing address:
  • Phone: 551-278-5898
  • Fax: 551-236-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MB08210000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: