Provider Demographics
NPI:1336744358
Name:VARGHESE, BIBIN THAMPY
Entity Type:Individual
Prefix:
First Name:BIBIN
Middle Name:THAMPY
Last Name:VARGHESE
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 1:20 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3615
Mailing Address - Country:US
Mailing Address - Phone:201-385-6262
Mailing Address - Fax:844-411-6907
Practice Address - Street 1:20 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3615
Practice Address - Country:US
Practice Address - Phone:201-385-6262
Practice Address - Fax:844-411-6907
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03156900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist