Provider Demographics
NPI:1609927995
Name:MATHEW, GLORY (FNP)
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1330
Mailing Address - Country:US
Mailing Address - Phone:914-968-3535
Mailing Address - Fax:914-968-3566
Practice Address - Street 1:1010 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1330
Practice Address - Country:US
Practice Address - Phone:914-968-3535
Practice Address - Fax:914-968-3566
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33-334698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1543G1Medicare ID - Type Unspecified