Provider Demographics
NPI:1770776239
Name:CABAS VARGAS, JENNY MARGARITA (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARGARITA
Last Name:CABAS VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 ROUTE 17M STE 7
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5236
Mailing Address - Country:US
Mailing Address - Phone:845-200-2995
Mailing Address - Fax:845-210-5787
Practice Address - Street 1:2002 ROUTE 17M STE 7
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5236
Practice Address - Country:US
Practice Address - Phone:845-200-2995
Practice Address - Fax:845-210-5787
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09220900207RR0500X
NY277775207RR0500X, 207RR0500X
PAMT190464390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04119779Medicaid