Healthcare Provider Details

I. General information

NPI: 1407856180
Provider Name (Legal Business Name): RINY MATHAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SOUTH BROADWAY
YONKERS NY
10701
US

IV. Provider business mailing address

107 WEST 4TH STREET
MOUNT VERNON NY
10550
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-4898
  • Fax: 914-968-5496
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: