Individual
SAM MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8251 251ST ST, BELLEROSE, NY 11426-2527
(347) 399-3402
Mailing address
8251 251ST ST, BELLEROSE, NY 11426-2527
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
766123
NY
Other
Enumeration date
11/17/2019
Last updated
11/17/2019
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