Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00228100 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00228100 | NJ |
NPI | 1063559029 |
---|---|
Provider Name | Dr. Michael Vincent Verdi |
First Address | West Orange, NJ 07052-2956 |
Second Address | West Orange, NJ 07052-2956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 21/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6582800 | (05) | NJ |
U55977 | (02) | NJ |