MEDICARE: MARY VARGHESE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046082	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760474753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY VARGHESE DDS

Provider Business Mailing Address
First Line	:	8 GOLDEN POND DR
Second Line	:
City	:	MILLTOWN
State	:	NJ
Zip	:	08850-2181
Country	:	US
Telephone Number	:	732-951-8089
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 MADISON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-7537
Country	:	US
Telephone Number	:	212-238-7506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/08/2007

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