Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 036157 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 40QA01304800 | NJ |
N | 2251G0304X | Physical Therapist - Geriatrics | PT017704 | PA |
NPI | 1104289826 |
---|---|
Provider Name | Beena Varghese |
First Address | Pomona, NY 10970 |
Second Address | Cherry Hill, NJ 08003-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 30/03/2016 |