Provider Demographics
NPI:1598993123
Name:VARGHESE, ROBIN (MD MS FRCSC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD MS FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 5TH AVE # 1028
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6503
Mailing Address - Country:US
Mailing Address - Phone:212-659-9360
Mailing Address - Fax:212-659-6818
Practice Address - Street 1:1190 5TH AVE # 1028
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-659-9630
Practice Address - Fax:212-659-6818
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252891-12086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03156232Medicaid
NYA400015023Medicare Oscar/Certification