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General NPI Number Information
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NPI Number | 1396894143
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Entity Type | Individual
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Provider Name | REBECCA B. VERGARA M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 HIGH ST
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City | NEWTON
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State | NJ
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Zip | 07860
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Country | US
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Telephone | 973-579-8715
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Fax | 973-383-1249
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Provider Business Mailing Address
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Address Line | 21 LINWOOD AVE
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City | NEWTON
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State | NJ
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Zip | 07860-1605
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Country | US
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Telephone | 973-383-8996
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Fax | 973-383-1249
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 25MA04857500
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License Number State | NJ
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