Healthcare Provider Details

I. General information

NPI: 1922661305
Provider Name (Legal Business Name): FASIL MATHEWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 QUEENS BLVD FL 6
FOREST HILLS NY
11375-4748
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 718-575-3322
  • Fax: 718-268-1920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number328051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: