Provider Demographics
NPI:1235136540
Name:VERNALEO, JOHN ROCCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROCCO
Last Name:VERNALEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21436 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2608
Mailing Address - Country:US
Mailing Address - Phone:718-229-1582
Mailing Address - Fax:
Practice Address - Street 1:21436 27TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2608
Practice Address - Country:US
Practice Address - Phone:718-229-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159105207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00970407Medicaid
NY34578Medicare ID - Type UnspecifiedGHI MEDICARE
NY34N611Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY00970407Medicaid