Provider Demographics
NPI:1679638886
Name:MATHEW, ROSE MARIE (DO)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:21 FOX STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4723
Mailing Address - Country:US
Mailing Address - Phone:845-452-9750
Mailing Address - Fax:845-452-9751
Practice Address - Street 1:200 WESTAGE BUS CTR DR.
Practice Address - Street 2:SUTIE 320
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2265
Practice Address - Country:US
Practice Address - Phone:845-452-9750
Practice Address - Fax:845-452-9751
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2384872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02962449Medicaid
NY02962449Medicaid