Healthcare Provider Details

I. General information

NPI: 1609047497
Provider Name (Legal Business Name): BETSY VARGHESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105-34 ROCKAWAY BLVD JOSEPH P. ADDABBO
OZONE PARK NY
11417
US

IV. Provider business mailing address

6200 BEACH CHANNEL DRIVE JOSEPH P. ADDABBO
ARVERNE NY
11692
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-945-2596
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number262647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: