Provider Demographics
NPI:1174850119
Name:VARGHESE, DANIEL (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 VANDERBILT PKWY
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5820
Mailing Address - Country:US
Mailing Address - Phone:516-639-6369
Mailing Address - Fax:
Practice Address - Street 1:681 SHERMAN COURT
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-639-6369
Practice Address - Fax:631-598-4723
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant