Provider Demographics
NPI:1790851061
Name:VERNON, GERALD MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MICHAEL
Last Name:VERNON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 US HIGHWAY 9 STE 108
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1575
Mailing Address - Country:US
Mailing Address - Phone:732-858-6638
Mailing Address - Fax:732-399-5463
Practice Address - Street 1:12 US HIGHWAY 9 STE 108
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1575
Practice Address - Country:US
Practice Address - Phone:732-858-6638
Practice Address - Fax:732-399-5463
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06424500207Q00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG33081Medicare UPIN
NJ885134SPPMedicare Oscar/Certification