Provider Demographics
NPI:1831487974
Name:VARGHESE, JENY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E RAY RD STE B201
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:480-935-3991
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:15352 76TH RD UNIT CF1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3183
Practice Address - Country:US
Practice Address - Phone:718-820-0120
Practice Address - Fax:718-820-0121
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281200207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04589759Medicaid
NY04589759Medicaid