Provider Demographics
NPI:1619181781
Name:VERNA, MATIAS AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MATIAS
Middle Name:AUGUSTO
Last Name:VERNA
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 1:45 POPHAM RD APT 1H
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4227
Mailing Address - Country:US
Mailing Address - Phone:646-202-2921
Mailing Address - Fax:646-786-3369
Practice Address - Street 1:45 POPHAM RD
Practice Address - Street 2:STE 1D
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4224
Practice Address - Country:US
Practice Address - Phone:646-202-2921
Practice Address - Fax:208-203-6415
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2342582084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY
NY234258OtherLICENSE
NY02449154OtherMEDICAD #
NYWVE061OtherMEDICARE #