Provider Demographics
NPI:1255516902
Name:MATHAI, JAIMINI (BS)
Entity type:Individual
Prefix:MRS
First Name:JAIMINI
Middle Name:
Last Name:MATHAI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4101
Mailing Address - Country:US
Mailing Address - Phone:212-925-5307
Mailing Address - Fax:212-925-2847
Practice Address - Street 1:4 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1168
Practice Address - Country:US
Practice Address - Phone:212-473-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041757-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist