Healthcare Provider Details

I. General information

NPI: 1245295500
Provider Name (Legal Business Name): ROBERT WALTER VERDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 4TH AVE
BROOKLYN NY
11209-8347
US

IV. Provider business mailing address

110 WADSWORTH RD
STATEN ISLAND NY
10305-3902
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-5565
  • Fax: 718-748-3526
Mailing address:
  • Phone: 718-442-0943
  • Fax: 718-442-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number149171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: