Healthcare Provider Details

I. General information

NPI: 1689589681
Provider Name (Legal Business Name): SAJAN MATHEW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25121 JERICHO TPKE # 1051
BELLEROSE NY
11426-2202
US

IV. Provider business mailing address

25121 JERICHO TPKE # 1051
BELLEROSE NY
11426-2202
US

V. Phone/Fax

Practice location:
  • Phone: 347-255-6125
  • Fax:
Mailing address:
  • Phone: 347-255-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: