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General NPI Number Information
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NPI Number | 1902257520
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Entity Type | Individual
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Provider Name | MITHUN JACOB VARGHESE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | C/O MARIA DIRECTO, MOUNT SINAI HOSPITAL ONE GUSTAVE LEVY PLACE, BOX 1030
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 516-737-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 1392 MADISON AVE APT 2
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City | NEW YORK
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State | NY
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Zip | 10029-6914
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Country | US
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Telephone | 516-737-5029
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | P00292
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License Number State | NY
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