MEDICARE: DR. IBELKA VARGAS

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	122300000X	Dentist	050317	NY

General Provider Information

NPI Number	:	1548465594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBELKA VARGAS

Provider Business Mailing Address
First Line	:	461 FORT WASHINGTON AVE
Second Line	:	SUITE #1
City	:	NEW YORK
State	:	NY
Zip	:	10033-4653
Country	:	US
Telephone Number	:	212-568-1003
Fax Number	:	212-568-5715

Provider Business Practice Location Address
First Line	:	461 FORT WASHINGTON AVE
Second Line	:	SUITE #1
City	:	NEW YORK
State	:	NY
Zip	:	10033-4653
Country	:	US
Telephone Number	:	212-568-1003
Fax Number	:	212-568-5715

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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