MEDICARE: MRS. VIJI MARY VERGIS PT

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	225100000X	Physical Therapist	025733	NY

General Provider Information

NPI Number	:	1700280898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIJI MARY VERGIS PT

Provider Business Mailing Address
First Line	:	133 TRAILS END
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-1309
Country	:	US
Telephone Number	:	845-825-3380
Fax Number	:

Provider Business Practice Location Address
First Line	:	28B INDIAN ROCK PLAZA
Second Line	:	RT. 59
City	:	MONTEBELLO
State	:	NY
Zip	:	10901-4907
Country	:	US
Telephone Number	:	845-368-2180
Fax Number	:	845-368-2187

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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