Healthcare Provider Details

I. General information

NPI: 1396208351
Provider Name (Legal Business Name): MATHEW SAJU VARGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W 118TH ST
NEW YORK NY
10026-1904
US

IV. Provider business mailing address

16064 19TH AVE
WHITESTONE NY
11357-3337
US

V. Phone/Fax

Practice location:
  • Phone: 212-369-8339
  • Fax:
Mailing address:
  • Phone: 718-309-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number318802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: