Provider Demographics
NPI:1629588785
Name:SHARON MATHEW
Entity Type:Organization
Organization Name:SHARON MATHEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:OTHER-OWNER
Authorized Official - Phone:845-729-7346
Mailing Address - Street 1:74 LINN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2503
Mailing Address - Country:US
Mailing Address - Phone:845-729-7346
Mailing Address - Fax:914-378-8535
Practice Address - Street 1:74 LINN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2503
Practice Address - Country:US
Practice Address - Phone:845-729-7346
Practice Address - Fax:914-378-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04701259Medicaid