Provider Demographics
NPI:1568530228
Name:VARUGHESE, JANCY J (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JANCY
Middle Name:J
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 KILBURN ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY SOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10201 66TH RD
Practice Address - Street 2:PST
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11875
Practice Address - Country:US
Practice Address - Phone:718-830-4177
Practice Address - Fax:718-830-1158
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3026341363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health