Basic Information
Provider Information
NPI: 1609047497
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VARGHESE
FirstName: BETSY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6200 BEACH CHANNEL DRIVE
Address2: JOSEPH P. ADDABBO
City: ARVERNE
State: NY
PostalCode: 11692
CountryCode: US
TelephoneNumber: 7189457150
FaxNumber: 7189452596
Practice Location
Address1: 105-34 ROCKAWAY BLVD
Address2: JOSEPH P. ADDABBO
City: OZONE PARK
State: NY
PostalCode: 11417
CountryCode: US
TelephoneNumber: 7189457150
FaxNumber: 7189452596
Other Information
ProviderEnumerationDate: 03/19/2008
LastUpdateDate: 02/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300X262647NYY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine

No ID Information.


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