Provider Demographics
NPI:1497514137
Name:MATHEMA, SURAJ BHAKTA (RD)
Entity Type:Individual
Prefix:
First Name:SURAJ
Middle Name:BHAKTA
Last Name:MATHEMA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 141ST ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1614
Mailing Address - Country:US
Mailing Address - Phone:347-431-6514
Mailing Address - Fax:
Practice Address - Street 1:8320 141ST ST APT 1B
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1614
Practice Address - Country:US
Practice Address - Phone:347-431-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered