Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00269800 | NJ |
NPI | 1003147976 |
---|---|
Provider Name | Mr. Sanju Varghese |
First Address | Warwick, NY 10990-1035 |
Second Address | Bergenfield, NJ 07621-4226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2010 |
Last Update Date | 17/10/2016 |