MEDICARE: MATHEW VARGHESE MD

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	25MA08720900	NJ
2	207R00000X	Internal Medicine Physician	25MA08720900	NJ

General Provider Information

NPI Number	:	1407884125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATHEW VARGHESE MD

Provider Business Mailing Address
First Line	:	8901 KENNEDY BLVD STE 4SW
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5344
Country	:	US
Telephone Number	:	201-374-1718
Fax Number	:	201-374-1719

Provider Business Practice Location Address
First Line	:	8901 KENNEDY BLVD STE 4SW
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5344
Country	:	US
Telephone Number	:	201-374-1718
Fax Number	:	201-374-1719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	06/04/2024

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