Provider Demographics
NPI:1386612596
Name:THE BOROUGH OF VERONA
Entity type:Organization
Organization Name:THE BOROUGH OF VERONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIFHER
Authorized Official - Suffix:
Authorized Official - Credentials:RNBS
Authorized Official - Phone:973-857-4800
Mailing Address - Street 1:600 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1804
Mailing Address - Country:US
Mailing Address - Phone:973-857-4800
Mailing Address - Fax:973-857-4828
Practice Address - Street 1:600 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1804
Practice Address - Country:US
Practice Address - Phone:973-857-4800
Practice Address - Fax:973-857-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ762140Medicare ID - Type UnspecifiedPROVIDER NUMBER