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General NPI Number Information
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NPI Number | 1578860383
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Entity Type | Individual
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Provider Name | ANU VARUGHESE THOMAS NP
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Gender | Male
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 101 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-2150
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Country | US
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Telephone | 631-444-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 58 MONTROSE DR
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City | COMMACK
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State | NY
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Zip | 11725-1330
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Country | US
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Telephone | 631-561-1998
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 310370
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License Number State | NY
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