Provider Demographics
NPI:1134418239
Name:VARGHESE, NANCY (NP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:23 CAROLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1903
Mailing Address - Country:US
Mailing Address - Phone:718-490-2153
Mailing Address - Fax:
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305435363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health