Provider Demographics
NPI:1740502194
Name:VERGHESE, CHERUVATHOOR SAMUEL (ND, PHD,)
Entity type:Individual
Prefix:DR
First Name:CHERUVATHOOR
Middle Name:SAMUEL
Last Name:VERGHESE
Suffix:
Gender:M
Credentials:ND, PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 E GATE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1238
Mailing Address - Country:US
Mailing Address - Phone:856-222-9965
Mailing Address - Fax:
Practice Address - Street 1:813 E GATE DR STE B
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1238
Practice Address - Country:US
Practice Address - Phone:856-222-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 173C00000X, 175F00000X
NJ26BT00015600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist