Individual
MON VERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 MADISON AVE FL 3, NEW YORK, NY 10022-3305
(646) 754-2000
(646) 754-9690
Mailing address
555 MADISON AVE, NEW YORK, NY 10022-3301
(646) 754-2000
(646) 754-9690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
251165
NY
207RI0200X
Infectious Disease Physician
Primary
251165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03093390
—
NY
01
—
1003236
CIGNA/GREAT WEST
NY
01
—
VR1165
ATLANTIS
NY
Enumeration date
09/29/2005
Last updated
08/03/2022
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