Provider Demographics
NPI:1477822153
Name:MATHEW, MILDA
Entity Type:Individual
Prefix:
First Name:MILDA
Middle Name:
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 1:27 GAIL DR
Mailing Address - Street 2:APT. B
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 GAIL DR
Practice Address - Street 2:APT. B
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1715
Practice Address - Country:US
Practice Address - Phone:845-825-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse