Provider Demographics
NPI:1316537079
Name:MATHEW, CHRISTY VARGHESE
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:VARGHESE
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 1:2096 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1902
Mailing Address - Country:US
Mailing Address - Phone:516-413-9055
Mailing Address - Fax:
Practice Address - Street 1:808A HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1262
Practice Address - Country:US
Practice Address - Phone:516-597-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346083-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine