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General NPI Number Information
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NPI Number | 1548736648
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Entity Type | Individual
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Provider Name | VYACHESLAV VERBETSKY NP-C
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Gender | Male
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 300 STAFFORD ST STE 101
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City | SPRINGFIELD
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State | MA
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Zip | 01104-3581
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Country | US
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Telephone | 413-732-1928
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Fax | 413-733-5604
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Provider Business Mailing Address
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Address Line | 300 STAFFORD ST STE 101
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City | SPRINGFIELD
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State | MA
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Zip | 01104-3581
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Country | US
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Telephone | 413-748-7076
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Fax | 413-732-0225
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2279149
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License Number State | MA
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