Provider Demographics
NPI:1336630714
Name:VARGHESE, GISHA
Entity Type:Individual
Prefix:
First Name:GISHA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELROD DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2816
Mailing Address - Country:US
Mailing Address - Phone:646-725-1831
Mailing Address - Fax:
Practice Address - Street 1:2411 ROUTE 82
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:NY
Practice Address - Zip Code:12510-9800
Practice Address - Country:US
Practice Address - Phone:845-223-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0607491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice