Provider Demographics
NPI:1063744951
Name:JOHN, VARGHESE P (PHD)
Entity type:Individual
Prefix:DR
First Name:VARGHESE
Middle Name:P
Last Name:JOHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEROY PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4520
Mailing Address - Country:US
Mailing Address - Phone:914-968-1126
Mailing Address - Fax:
Practice Address - Street 1:24 LEROY PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4520
Practice Address - Country:US
Practice Address - Phone:914-968-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist