Provider Demographics
NPI:1700369949
Name:VARGHESE, MANJU (FNP)
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MANJU
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:356 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4343
Mailing Address - Country:US
Mailing Address - Phone:631-858-0400
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD STE 100B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3631
Practice Address - Country:US
Practice Address - Phone:631-425-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily