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General NPI Number Information
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NPI Number | 1235214545
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Entity Type | Individual
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Provider Name | JOE VERGHESE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | NEUROLOGY ASSOCIATES OF STONY BROOK 4 SMITH HAVEN MALL SUITE 105
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City | LAKE GROVE
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State | NY
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Zip | 11755
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Country | US
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Telephone | 631-444-2599
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Fax | 631-392-7213
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Provider Business Mailing Address
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Address Line | 10 BELL CIRCLE ROAD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-444-8118
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Fax | 631-392-7213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 232009
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License Number State | NY
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