Provider Demographics
NPI:1235214545
Name:VERGHESE, JOE (MD)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:VERGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BELL CIRCLE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-444-8118
Mailing Address - Fax:631-392-7213
Practice Address - Street 1:NEUROLOGY ASSOCIATES OF STONY BROOK
Practice Address - Street 2:4 SMITH HAVEN MALL SUITE 105
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:631-392-7213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2320092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology