MEDICARE: DR. JESSIE 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	207R00000X	Internal Medicine Physician	042047	CT
2	207QA0505X	Adult Medicine Physician	231327	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010042047CT02	OTHER	CT	BCBS

General Provider Information

NPI Number	:	1831149731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE VARGHESE MD

Provider Business Mailing Address
First Line	:	300 LUCILLE AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3414
Country	:	US
Telephone Number	:	917-651-6022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2418
Country	:	US
Telephone Number	:	631-425-5250
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/17/2025

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