Provider Demographics
NPI:1649896887
Name:VARGHESE, BIJU MATHEW (PTA)
Entity type:Individual
Prefix:MR
First Name:BIJU
Middle Name:MATHEW
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2912
Mailing Address - Country:US
Mailing Address - Phone:516-384-7150
Mailing Address - Fax:
Practice Address - Street 1:454 LINDA DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2912
Practice Address - Country:US
Practice Address - Phone:516-384-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006392225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty