1790059905 NPI number — MRS. O'BELLA FUSINGAN VERDEFLOR

Table of content: MRS. O'BELLA FUSINGAN VERDEFLOR (NPI 1790059905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790059905 NPI number — MRS. O'BELLA FUSINGAN VERDEFLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERDEFLOR
Provider First Name:
O'BELLA
Provider Middle Name:
FUSINGAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUSINGA
Provider Other First Name:
O'BELLA
Provider Other Middle Name:
SAMILLANO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790059905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 WATSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08879-2572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-313-6060
Provider Business Mailing Address Fax Number:
732-313-6060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WATSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08879-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-313-6060
Provider Business Practice Location Address Fax Number:
732-313-6060
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  26NJ00350400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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