Provider Demographics
NPI:1295754638
Name:VARRIALE, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:VARRIALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 19TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2607
Mailing Address - Country:US
Mailing Address - Phone:212-777-3219
Mailing Address - Fax:212-473-1336
Practice Address - Street 1:222 E 19TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2607
Practice Address - Country:US
Practice Address - Phone:212-777-3219
Practice Address - Fax:212-473-1336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY84399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0097686OtherAETNA HMO #
NY4276958OtherAETNA PPO #
NYVP4399OtherATLANTIS HEALTH PLAN #
NY164971OtherEMPIRE BC/BS #
NY00127220Medicaid
NYNS3992OtherOXFORD #
NY084399OtherHIP #
NY4C9071OtherHEALTHNET #
NY0037630OtherGHI PPO #
NY084399OtherWORKERS COMPENSATION #
NY00127220Medicaid
NYNS3992OtherOXFORD #