Provider Demographics
NPI:1841383692
Name:MIGUEL VARGAS MD PC
Entity Type:Organization
Organization Name:MIGUEL VARGAS MD PC
Other - Org Name:MEDICAL SPORTS REHAB OF MASPETH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-984-3206
Mailing Address - Street 1:1 EDGEWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2742
Mailing Address - Country:US
Mailing Address - Phone:631-979-8508
Mailing Address - Fax:631-979-0998
Practice Address - Street 1:1 EDGEWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2742
Practice Address - Country:US
Practice Address - Phone:631-979-8508
Practice Address - Fax:631-979-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02802766Medicaid
NY07131Medicare PIN
NY02802766Medicaid
NYH71642Medicare UPIN