Provider Demographics
NPI:1134479678
Name:VERGHESE, VEENA (OD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:VERGHESE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1325
Mailing Address - Country:US
Mailing Address - Phone:201-684-9000
Mailing Address - Fax:201-684-9002
Practice Address - Street 1:115 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1325
Practice Address - Country:US
Practice Address - Phone:201-684-9000
Practice Address - Fax:201-684-9002
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ27OA00695000152W00000X
CA14576TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 14576OtherLICENSE