Provider Demographics
NPI:1295922664
Name:VERONA FAMILY PRACTICE
Entity type:Organization
Organization Name:VERONA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:315-363-3482
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:5648 EAST MAIN ST
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-0169
Mailing Address - Country:US
Mailing Address - Phone:315-363-3482
Mailing Address - Fax:315-363-1597
Practice Address - Street 1:5648 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3533
Practice Address - Country:US
Practice Address - Phone:315-363-3482
Practice Address - Fax:315-363-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0741Medicare PIN