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General NPI Number Information
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NPI Number | 1114736592
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Entity Type | Individual
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Provider Name | JASON ROBERT VERDISCO PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 405 E 75TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-3102
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Country | US
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Telephone | 646-714-6850
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Fax |
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Provider Business Mailing Address
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Address Line | 25 PARK AVE APT 91
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City | VERONA
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State | NJ
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Zip | 07044-2405
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Country | US
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Telephone | 631-258-4821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02291100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 053306-01
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License Number State | NY
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