Provider Demographics
NPI:1518146596
Name:MATHEW, SUJA ABY (BPHARM)
Entity type:Individual
Prefix:MRS
First Name:SUJA
Middle Name:ABY
Last Name:MATHEW
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5315
Mailing Address - Country:US
Mailing Address - Phone:845-368-4682
Mailing Address - Fax:845-368-4694
Practice Address - Street 1:250 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5315
Practice Address - Country:US
Practice Address - Phone:845-368-4682
Practice Address - Fax:845-368-4694
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045124-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist