Individual
MR. JACOB K MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
475 E MAIN ST STE 205, PATCHOGUE, NY 11772-3121
(631) 394-2550
(631) 654-1474
Mailing address
100 OAKLAND AVE, SUITE 4, PORT JEFFERSON, NY 11777-2172
(631) 476-4780
(631) 476-4781
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
196027
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01494779
—
NY
Enumeration date
08/10/2005
Last updated
03/09/2026
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