Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 266066 | NY |
Y | 111NI0900X | Internist | 266066 | NY |
NPI | 1003049867 |
---|---|
Provider Name | Dr. Anitha Sara Mathew-Shaji |
First Address | Mineola, NY 11501-4112 |
Second Address | Mineola, NY 11501-4112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 25/04/2019 |