Provider Demographics
NPI:1255664777
Name:MANOJ VARGHESE THOMAS, PT PLLC
Entity Type:Organization
Organization Name:MANOJ VARGHESE THOMAS, PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:VARGHESE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:718-278-2500
Mailing Address - Street 1:2519 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2945
Mailing Address - Country:US
Mailing Address - Phone:718-278-2500
Mailing Address - Fax:718-278-0600
Practice Address - Street 1:2519 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2945
Practice Address - Country:US
Practice Address - Phone:718-278-2500
Practice Address - Fax:718-278-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022228273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit