Provider Demographics
NPI:1740898402
Name:POOH, VERA
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:POOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 73RD ST APT 219
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2258
Mailing Address - Country:US
Mailing Address - Phone:347-269-9505
Mailing Address - Fax:
Practice Address - Street 1:191 73RD ST APT 219
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2258
Practice Address - Country:US
Practice Address - Phone:347-269-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2710392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist