MEDICARE: NORTHERN VALLEY ALLERGY ASTHMA AND SINUS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician

General Provider Information

NPI Number	:	1083922314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VALLEY ALLERGY ASTHMA AND SINUS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 5272
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-5272
Country	:	US
Telephone Number	:	201-374-1718
Fax Number	:	201-374-1719

Provider Business Practice Location Address
First Line	:	79 E PUTNAM AVE STE 19
Second Line	:
City	:	GREENWICH
State	:	CT
Zip	:	06830-5644
Country	:	US
Telephone Number	:	607-379-2401
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATHEW VARGHESE
Credential	:	MD
Telephone Number	:	201-374-1718

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	12/15/2025

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