Provider Demographics
NPI:1154435527
Name:MEDICENTER ONE OF BAYONNE
Entity type:Organization
Organization Name:MEDICENTER ONE OF BAYONNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERNESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-436-1122
Mailing Address - Street 1:P.O. BOX 640
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-759-8700
Mailing Address - Fax:973-759-7545
Practice Address - Street 1:738 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1838
Practice Address - Country:US
Practice Address - Phone:201-436-1122
Practice Address - Fax:201-437-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty