Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MA08720900 | NJ |
N | 207R00000X | Internist | 25MA08720900 | NJ |
N | 111NI0900X | Internist | 25MA08720900 | NJ |
NPI | 1407884125 |
---|---|
Provider Name | Mathew Varghese |
First Address | Bergenfield, NJ 07621-1776 |
Second Address | Bergenfield, NJ 07621-1776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 22/11/2011 |