Provider Demographics
NPI:1477151181
Name:VERDIEU, STANLEY ROBERT JR
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ROBERT
Last Name:VERDIEU
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3249
Mailing Address - Country:US
Mailing Address - Phone:718-241-7490
Mailing Address - Fax:
Practice Address - Street 1:801 E 241ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1303
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:718-671-1269
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339770164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse