Provider Demographics
NPI:1275563934
Name:VARGHESE, REBECCA M (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2536
Mailing Address - Country:US
Mailing Address - Phone:201-775-1153
Mailing Address - Fax:845-675-5005
Practice Address - Street 1:8 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2536
Practice Address - Country:US
Practice Address - Phone:201-775-1153
Practice Address - Fax:845-675-5005
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06805500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH93678Medicare UPIN
NJ073081Medicare ID - Type Unspecified