Provider Demographics
NPI:1497039416
Name:VARUGHESE, BEENA JOHNSON (NP)
Entity type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:JOHNSON
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BEENA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1934
Mailing Address - Country:US
Mailing Address - Phone:516-326-2478
Mailing Address - Fax:
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7810
Practice Address - Fax:718-470-4320
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336744-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily