Provider Demographics
NPI:1649711086
Name:VARELA ARREGOCES, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:VARELA ARREGOCES
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 1:641 LEXINGTON AVE
Mailing Address - Street 2:622
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4503
Mailing Address - Country:US
Mailing Address - Phone:201-936-8867
Mailing Address - Fax:
Practice Address - Street 1:641 LEXINGTON AVE
Practice Address - Street 2:622
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4503
Practice Address - Country:US
Practice Address - Phone:201-936-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYKZ3HZN18134430OtherHORIZON BLUE CROSS SHIELD OF NEW JERSEY