Provider Demographics
NPI:1548572159
Name:JP VERDISCO EXERCISE HEALTH AND FITNESS INC.
Entity Type:Organization
Organization Name:JP VERDISCO EXERCISE HEALTH AND FITNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL EXERCISE PHYSIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VERDISCO
Authorized Official - Suffix:
Authorized Official - Credentials:BA/MA
Authorized Official - Phone:631-880-3810
Mailing Address - Street 1:1305 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2554
Mailing Address - Country:US
Mailing Address - Phone:631-880-3810
Mailing Address - Fax:
Practice Address - Street 1:1305 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2554
Practice Address - Country:US
Practice Address - Phone:631-880-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0147861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty