Healthcare Provider Details

I. General information

NPI: 1164469540
Provider Name (Legal Business Name): JORGE L. VEREA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BROADWAY
WEST NEW YORK NJ
07093-3112
US

IV. Provider business mailing address

6500 BROADWAY
WEST NEW YORK NJ
07093-3112
US

V. Phone/Fax

Practice location:
  • Phone: 201-864-3456
  • Fax: 201-869-7224
Mailing address:
  • Phone: 201-864-3456
  • Fax: 201-869-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number47302
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: