Provider Demographics
NPI:1770626111
Name:VERGA, DIANE GLORIA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:GLORIA
Last Name:VERGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8175
Mailing Address - Country:US
Mailing Address - Phone:848-223-7120
Mailing Address - Fax:732-349-6919
Practice Address - Street 1:13-21 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3311
Practice Address - Country:US
Practice Address - Phone:201-791-2900
Practice Address - Fax:201-791-3241
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04904700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3368807-01Medicaid
NJC55191Medicare UPIN
NJ3368807-01Medicaid