Provider Demographics
NPI:1699060590
Name:VERZOSA, FREDDIE C (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:C
Last Name:VERZOSA
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 1:1 RIVER PL
Mailing Address - Street 2:APARTMENT 406
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4343
Mailing Address - Country:US
Mailing Address - Phone:917-855-9949
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM STREET
Practice Address - Street 2:WYCKOFF HEIGHTS MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:718-963-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257614207R00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine