Provider Demographics
NPI:1336463371
Name:VARGHESE, TINY KANNADAN (MD)
Entity Type:Individual
Prefix:
First Name:TINY
Middle Name:KANNADAN
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1319
Mailing Address - Country:US
Mailing Address - Phone:516-785-5050
Mailing Address - Fax:
Practice Address - Street 1:701 HOOVER ST
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1319
Practice Address - Country:US
Practice Address - Phone:516-785-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54687207R00000X
NY274321207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine