Healthcare Provider Details

I. General information

NPI: 1538407705
Provider Name (Legal Business Name): GEORGE DANIEL VERMENTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E TREMONT AVE
BRONX NY
10460-2306
US

IV. Provider business mailing address

1109 ADEE AVE
BRONX NY
10469-5117
US

V. Phone/Fax

Practice location:
  • Phone: 929-385-4299
  • Fax: 646-395-3823
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number280871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: