MEDICARE: ELIZABETH E VERGOZ PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0117161	NY
2	103T00000X	Psychologist	4253	NJ

General Provider Information

NPI Number	:	1205840600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH E VERGOZ PH D

Provider Business Mailing Address
First Line	:	65 N MAPLE AVE
Second Line	:	SUITE 301
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3233
Country	:	US
Telephone Number	:	201-655-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 N MAPLE AVE
Second Line	:	SUITE 301
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3233
Country	:	US
Telephone Number	:	201-655-5434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/24/2021

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Directions to “ ELIZABETH E VERGOZ PH D” Practice Location

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