Provider Demographics
NPI:1821436114
Name:VARUGHESE, AMBILY (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBILY
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 AVENUE AT PORT IMPERIAL
Mailing Address - Street 2:APT. 823
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6944
Mailing Address - Country:US
Mailing Address - Phone:201-220-1331
Mailing Address - Fax:
Practice Address - Street 1:455 COLONIAL TER
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1403
Practice Address - Country:US
Practice Address - Phone:201-753-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00715000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist