=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669521357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERRET MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 10/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 MAIN ST
-----------------------------------------------------
City | PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07503-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-754-3182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 MONTEREY DR
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-6537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-945-1202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JOSEPH MARC VERRET
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-945-1202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA49872
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------