Healthcare Provider Details

I. General information

NPI: 1326629379
Provider Name (Legal Business Name): VERGELIA WOODS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY
PARAMUS NJ
07652-4100
US

IV. Provider business mailing address

416 MAPLEWOOD AVE
CLIFTON NJ
07013-1477
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-8507
  • Fax:
Mailing address:
  • Phone: 551-243-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number26NOO9871000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: