Healthcare Provider Details

I. General information

NPI: 1508941832
Provider Name (Legal Business Name): STALIN VARUGHESE RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FRANKLIN AVE
VALLEY STREAM NY
11580-2145
US

IV. Provider business mailing address

116 S CHERRY VALLEY AVE
W HEMPSTEAD NY
11552-2343
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-6000
  • Fax: 516-256-6085
Mailing address:
  • Phone: 516-489-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: