Individual
DR. JESUS ROBERTO VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 E CATHERINE ST, SUITE 110, MILFORD, PA 18337-1347
(570) 296-4600
(570) 409-1965
Mailing address
532 LAFAYETTE RD, SUITE 300, SPARTA, NJ 07871-4411
(973) 940-0423
(973) 940-0399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA04749800
NJ
207R00000X
Internal Medicine Physician
Primary
MD038493E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010050488
NJ RAILROAD MEDICARE
NJ
01
—
010051532
PA RAILROAD MEDICARE
PA
05
—
6749305
—
NJ
Enumeration date
12/29/2005
Last updated
02/06/2017
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