Individual provider Active NPI

Justin Varghese, MD

  • Internal Medicine Physician
  • Bronx, NY
National Provider Identifier
1881850006
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
255469 Issued in NY
Practice address
2532 Grand Concourse
Bronx, NY 10458-4902
Phone
(718) 960-1500
Fax
(718) 960-2178
NPI assigned
Aug 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 255469 NY Primary

Addresses

Primary practice location

2532 Grand Concourse
Bronx, NY 10458-4902

Mailing address

2532 Grand Concourse
Bronx, NY 10458-4902
Phone (718) 960-1500

Other identifiers 1

IdentifierTypeStateIssuer
255469OtherNYLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100528000309 NY Practitioner - Internal Medicine 8527197631 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Internal Medicine CurrentSince Apr 13, 2018 Accepting new patients
Montefiore Medical Center CurrentSince Apr 13, 2018 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

2532 Grand Concourse
Bronx, NY 10458
Phone (718) 960-1500

2100 Bartow Ave
Bronx, NY 10475
Phone (718) 320-5300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1881850006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2532 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104584902",
            "telephone_number": "718-960-1500",
            "fax_number": "718-960-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2532 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104584902",
            "telephone_number": "718-960-1500",
            "fax_number": "718-960-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-07",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "255469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "255469",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.