Provider Demographics
NPI:1407517048
Name:VERDEJO, NANCY ANN
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:VERDEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:FRANCISCO
Other - Middle Name:A
Other - Last Name:RIVERA
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2326 THROOP AVE STE BASEMENT
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5712
Mailing Address - Country:US
Mailing Address - Phone:646-270-1669
Mailing Address - Fax:
Practice Address - Street 1:2326 THROOP AVE STE BASEMENT
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5712
Practice Address - Country:US
Practice Address - Phone:646-270-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver