Basic Information
| Provider Information | |||||||||
| NPI: | 1801822622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERNA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CLARICE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27036 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123050914 | ||||||||
| FaxNumber: | 2123054343 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 W 168TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123050914 | ||||||||
| FaxNumber: | 2123054343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RT0003X | 237425 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 02768876 | 05 | NY | MEDICAID |