Provider Demographics
NPI:1679991814
Name:MATHEW, GYOLTZNA MARIAM (CF-SLP)
Entity Type:Individual
Prefix:
First Name:GYOLTZNA
Middle Name:MARIAM
Last Name:MATHEW
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:GYOLTZNA
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2929 BAINBRIDGE AVE
Mailing Address - Street 2:APT 5G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2929 BAINBRIDGE AVE
Practice Address - Street 2:APT 5G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2825
Practice Address - Country:US
Practice Address - Phone:516-984-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist