Provider Demographics
NPI:1245596113
Name:MATHEWS, RUBY
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:
Last Name:MATHEWS
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 1:333 E 4TH ST
Mailing Address - Street 2:ROOM 405
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6912
Mailing Address - Country:US
Mailing Address - Phone:212-777-4103
Mailing Address - Fax:212-777-4102
Practice Address - Street 1:333 E 4TH ST
Practice Address - Street 2:ROOM 405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6912
Practice Address - Country:US
Practice Address - Phone:212-777-4103
Practice Address - Fax:212-777-4102
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014001-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist