Provider Demographics
NPI:1679508055
Name:MATHIEU, CLAUDINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDINE
Middle Name:R
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2984
Mailing Address - Country:US
Mailing Address - Phone:516-216-5910
Mailing Address - Fax:516-216-5907
Practice Address - Street 1:77 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2984
Practice Address - Country:US
Practice Address - Phone:516-216-5910
Practice Address - Fax:516-216-5907
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02318656Medicaid