Provider Demographics
NPI:1407952310
Name:GEORGE, VERGHESE (MD)
Entity Type:Individual
Prefix:
First Name:VERGHESE
Middle Name:
Last Name:GEORGE
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 1:811 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2208
Mailing Address - Country:US
Mailing Address - Phone:631-249-3000
Mailing Address - Fax:631-249-1878
Practice Address - Street 1:811 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2208
Practice Address - Country:US
Practice Address - Phone:631-249-3000
Practice Address - Fax:631-249-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148203174400000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00841492Medicaid
NY00841492Medicaid
NYE28825Medicare UPIN