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General NPI Number Information
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NPI Number | 1659138501
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Entity Type | Individual
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Provider Name | MARINA LYNN VERHAGEN OD
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Gender | Female
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 170 CHANGEBRIDGE RD BLDG B5
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City | MONTVILLE
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State | NJ
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Zip | 07045-9114
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Country | US
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Telephone | 973-835-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 170 CHANGEBRIDGE RD BLDG B5
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City | MONTVILLE
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State | NJ
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Zip | 07045-9114
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00726300
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License Number State | NJ
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