Provider Demographics
NPI:1396844148
Name:VERZOSA, OSCAR E (MD, PA)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:E
Last Name:VERZOSA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4147
Mailing Address - Country:US
Mailing Address - Phone:908-587-9300
Mailing Address - Fax:908-587-1901
Practice Address - Street 1:520 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4147
Practice Address - Country:US
Practice Address - Phone:908-587-9300
Practice Address - Fax:908-587-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3634302Medicaid
NJ3634302Medicaid
NJC56722Medicare UPIN