Basic Information
| Provider Information | |||||||||
| NPI: | 1407856180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHAI | ||||||||
| FirstName: | RINY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WEST 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146997200 | ||||||||
| FaxNumber: | 9146990837 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 SOUTH BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149684898 | ||||||||
| FaxNumber: | 9149685496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 11/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 221500 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02212908 | 05 | NY | MEDICAID |