Provider Demographics
NPI:1770831109
Name:MATHEW VARGHESE, MELISSA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MATHEW VARGHESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:600 COMMUNITY DR
Mailing Address - Street 2:304
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3802
Mailing Address - Country:US
Mailing Address - Phone:516-823-8010
Mailing Address - Fax:516-823-8290
Practice Address - Street 1:600 COMMUNITY DR
Practice Address - Street 2:304
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-823-8010
Practice Address - Fax:516-823-8290
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF305933-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health