Healthcare Provider Details

I. General information

NPI: 1073702122
Provider Name (Legal Business Name): JEFFREY E. VERGALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 1400
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number338505-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: