Provider Demographics
NPI:1508941832
Name:VARUGHESE, STALIN (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:STALIN
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S CHERRY VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2343
Mailing Address - Country:US
Mailing Address - Phone:516-489-6948
Mailing Address - Fax:
Practice Address - Street 1:900 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2145
Practice Address - Country:US
Practice Address - Phone:516-256-6000
Practice Address - Fax:516-256-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant