Provider Demographics
NPI:1063409621
Name:VERA, MON (MD)
Entity type:Individual
Prefix:
First Name:MON
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3301
Mailing Address - Country:US
Mailing Address - Phone:646-754-2000
Mailing Address - Fax:646-754-9690
Practice Address - Street 1:555 MADISON AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3305
Practice Address - Country:US
Practice Address - Phone:646-754-2000
Practice Address - Fax:646-754-9690
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251165207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03093390Medicaid
NY1003236OtherCIGNA/GREAT WEST
NYVR1165OtherATLANTIS
NY03093390Medicaid