Individual
THANKAMMA MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7925 WINCHESTER BLVD, QUEENS VILLAGE, NY 11427-2128
(718) 264-4050
Mailing address
7925 WINCHESTER BLVD, QUEENS VILLAGE, NY 11427-2128
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
450647
NY
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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