Provider Demographics
NPI:1609815976
Name:VERGARI, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:VERGARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-845-6807
Mailing Address - Fax:856-845-3760
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-845-6807
Practice Address - Fax:856-845-3760
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA44129207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114465000OtherKEYSTONE HEALTH PLAN
NJ110099861OtherRAILROAD MEDICARE
PA0114465000OtherPA BLUE SHIELD
NJ2222173875OtherNJ BLUE SHIELD
NJP505112OtherOXFORD
NJ1048281OtherHORIZON MERCY
NJ531070OtherAMERIHEALTH ADMINISTRATOR
NJ0114465000OtherAMERIHEALTH
NJ0629502Medicaid
PA0114465000OtherPA BLUE SHIELD
NJP505112OtherOXFORD
NJ0629502Medicaid