Provider Demographics
NPI:1811988801
Name:VERLENI, GUST P (PA)
Entity type:Individual
Prefix:
First Name:GUST
Middle Name:P
Last Name:VERLENI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-661-1583
Mailing Address - Fax:
Practice Address - Street 1:890 E SECOND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-661-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006801363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02341977Medicaid
NYPA1893Medicare PIN
NYPA1889Medicare PIN
NY02341977Medicaid
NYPA1892Medicare PIN
NYPA1895Medicare PIN
NYCC1487Medicare ID - Type Unspecified
NYPA1891Medicare PIN
NYP11671Medicare UPIN
NYPA1990Medicare PIN
PA0989Medicare PIN