Provider Demographics
NPI:1669734117
Name:VERDUZCO, ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VERDUZCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CEBALLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6 ROMA ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1724
Mailing Address - Country:US
Mailing Address - Phone:551-225-5314
Mailing Address - Fax:
Practice Address - Street 1:113 14TH ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5545
Practice Address - Country:US
Practice Address - Phone:201-795-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09611700208600000X
NY290305-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFV6947406OtherDEA