Healthcare Provider Details

I. General information

NPI: 1679638886
Provider Name (Legal Business Name): ROSE MARIE MATHEW DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTAGE BUS CTR DR. SUTIE 320
FISHKILL NY
12524-2265
US

IV. Provider business mailing address

21 FOX STREET SUITE 102
POUGHKEEPSIE NY
12601-4723
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-9750
  • Fax: 845-452-9751
Mailing address:
  • Phone: 845-452-9750
  • Fax: 845-452-9751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number238487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: