Provider Demographics
NPI:1750436994
Name:MATHEW, SAMUEL
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:MATHEW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SGT PARKER RD
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913
Mailing Address - Country:US
Mailing Address - Phone:845-359-5047
Mailing Address - Fax:845-359-5901
Practice Address - Street 1:71,SOUTH BROAD WAY,ESTHER PHARMACY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-965-2661
Practice Address - Fax:914-965-2853
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist