Healthcare Provider Details

I. General information

NPI: 1083922314
Provider Name (Legal Business Name): NORTHERN VALLEY ALLERGY ASTHMA AND SINUS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 E PUTNAM AVE STE 19
GREENWICH CT
06830-5644
US

IV. Provider business mailing address

PO BOX 5272
BERGENFIELD NJ
07621-5272
US

V. Phone/Fax

Practice location:
  • Phone: 607-379-2401
  • Fax:
Mailing address:
  • Phone: 201-374-1718
  • Fax: 201-374-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MATHEW VARGHESE
Title or Position: OWNER
Credential: MD
Phone: 201-374-1718