Provider Demographics
NPI:1902208242
Name:MATHEW, ALEXANDER T (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:T
Last Name:MATHEW
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JUDITH ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2413
Mailing Address - Country:US
Mailing Address - Phone:845-269-1288
Mailing Address - Fax:845-651-2258
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3439
Practice Address - Country:US
Practice Address - Phone:914-373-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2020-11-27
Deactivation Date:2020-11-19
Deactivation Code:
Reactivation Date:2020-11-24
Provider Licenses
StateLicense IDTaxonomies
NY008413-1224Z00000X
NY025243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant