Provider Demographics
NPI:1982804282
Name:WAKS, VERONICA G (ND)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:G
Last Name:WAKS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5234
Mailing Address - Country:US
Mailing Address - Phone:215-240-0838
Mailing Address - Fax:
Practice Address - Street 1:25 3RD ST STE 320
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5129
Practice Address - Country:US
Practice Address - Phone:203-331-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000359175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110000359CT01OtherANTHEM BLUE CROSS BLUE SH