Healthcare Provider Details

I. General information

NPI: 1548793334
Provider Name (Legal Business Name): ALWIN MATHEW M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST 'N' BUILDING ROOM 705
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

2510 30TH AVE
ASTORIA NY
11102-2448
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4080
  • Fax:
Mailing address:
  • Phone: 718-932-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number305771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: