Healthcare Provider Details

I. General information

NPI: 1871137646
Provider Name (Legal Business Name): JINU MATHEW THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 HEMPSTEAD TPKE FL 3
BETHPAGE NY
11714-5611
US

IV. Provider business mailing address

263 BRYANT AVE
FLORAL PARK NY
11001-1223
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-7770
  • Fax:
Mailing address:
  • Phone: 914-471-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: