Provider Demographics
NPI:1578542346
Name:VARGAS, MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:VARGAS
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 1:87 W OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4003
Mailing Address - Country:US
Mailing Address - Phone:516-433-1100
Mailing Address - Fax:516-433-1342
Practice Address - Street 1:87 W OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4003
Practice Address - Country:US
Practice Address - Phone:156-433-1100
Practice Address - Fax:164-331-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213808208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400061093Medicare PIN
NY1206J1Medicare ID - Type Unspecified
NYH71642Medicare UPIN