Provider Demographics
NPI:1912118100
Name:MATHEW, ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2430 W 3RD ST
Mailing Address - Street 2:APT#1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5930
Mailing Address - Country:US
Mailing Address - Phone:718-646-0772
Mailing Address - Fax:718-646-0772
Practice Address - Street 1:15211 89TH AVE
Practice Address - Street 2:MARY IMMACULATE HOSPITAL
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3730
Practice Address - Country:US
Practice Address - Phone:718-558-2077
Practice Address - Fax:718-558-9598
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2268862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry