Provider Demographics
NPI:1518486455
Name:MATHEW, CHRISTIE GEORGE
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:GEORGE
Last Name:MATHEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CROSSWAYS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2002
Mailing Address - Country:US
Mailing Address - Phone:516-422-8080
Mailing Address - Fax:516-992-4637
Practice Address - Street 1:70 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4225
Practice Address - Country:US
Practice Address - Phone:516-536-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist