Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA06044100 | NJ |
N | 2080P0208X | Pediatric Infectious Diseases | 25MA06044100 | NJ |
NPI | 1518907773 |
---|---|
Provider Name | Renuka Verma |
First Address | Buffalo, NY 14267-0002 |
Second Address | Long Branch, NJ 07740-6303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6599303 | (05) | NJ |
G13512 | (02) | NJ |