Provider Demographics
NPI:1093590044
Name:MATHEW, PEARLY RACHEL
Entity Type:Individual
Prefix:
First Name:PEARLY
Middle Name:RACHEL
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2394 GLADMORE ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3117
Mailing Address - Country:US
Mailing Address - Phone:516-974-1409
Mailing Address - Fax:
Practice Address - Street 1:2394 GLADMORE ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3117
Practice Address - Country:US
Practice Address - Phone:516-974-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY727443-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse