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1205840600 NPI number — ELIZABETH E VERGOZ PH D

NPI Number: 1205840600
Health Care Provider/Practitioner: ELIZABETH E VERGOZ PH D

Information about “1205840600” NPI (ELIZABETH E VERGOZ PH D) exists in 1205840600 in HTML format HTML  |  1205840600 in plain Text format TXT  |  1205840600 in PDF (Portable Document Format) PDF  |  1205840600 in an XML format XML  formats.

NPI Number : 1205840600 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205840600",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VERGOZ",
    "FirstName": "ELIZABETH",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PH D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VERGOZ-REKIS",
    "OtherFirstName": "ELIZABETH",
    "OtherMiddleName": "E",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PH D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "65 N MAPLE AVE",
    "SecondLineMailingAddress": "SUITE 301",
    "MailingAddressCityName": "RIDGEWOOD",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07450-3233",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-655-5434",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "65 N MAPLE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 301",
    "PracticeLocationAddressCityName": "RIDGEWOOD",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07450-3233",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-655-5434",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/28/2006",
    "LastUpdateDate": "08/24/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "0117161",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "4253",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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