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General NPI Number Information
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NPI Number | 1407884125
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Entity Type | Individual
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Provider Name | MATHEW VARGHESE MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 8901 KENNEDY BLVD STE 4SW
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-5344
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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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Provider Business Mailing Address
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Address Line | 8901 KENNEDY BLVD STE 4SW
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-5344
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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 |
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | 25MA08720900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08720900
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License Number State | NJ
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