Provider Demographics
NPI:1841203940
Name:VERGILIO, CORY D (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:D
Last Name:VERGILIO
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 1:319 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3109
Mailing Address - Country:US
Mailing Address - Phone:908-203-0900
Mailing Address - Fax:908-203-0990
Practice Address - Street 1:319 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3109
Practice Address - Country:US
Practice Address - Phone:908-203-0900
Practice Address - Fax:908-203-0990
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55433207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6356206Medicaid
NJ6356206Medicaid
E97839Medicare UPIN