Provider Demographics
NPI:1407884125
Name:VARGHESE, MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
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 1:136 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1776
Mailing Address - Country:US
Mailing Address - Phone:201-374-1718
Mailing Address - Fax:201-374-1719
Practice Address - Street 1:136 N WASHINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1776
Practice Address - Country:US
Practice Address - Phone:201-374-1718
Practice Address - Fax:201-374-1719
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08720900207KA0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ199266Medicare PIN