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General NPI Number Information
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NPI Number | 1083922314
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Entity Type | Organization
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Legal Business Name | NORTHERN VALLEY ALLERGY ASTHMA AND SINUS CENTER LLC
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 79 E PUTNAM AVE STE 19
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City | GREENWICH
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State | CT
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Zip | 06830-5644
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Country | US
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Telephone | 607-379-2401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5272
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City | BERGENFIELD
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State | NJ
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Zip | 07621-5272
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Country | US
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Telephone | 201-374-1718
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Fax | 201-374-1719
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Authorized Official
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Title or Position | OWNER
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Name | MATHEW VARGHESE
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Credential | MD
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Telephone | 201-374-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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