Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00481700 | NJ |
NPI | 1003907627 |
---|---|
Provider Name | Dr. Victor T Verlezza |
First Address | East Orange, NJ 07018-2835 |
Second Address | East Orange, NJ 07018-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0021849 | (05) | NJ |
U65625 | (02) | NJ |