Healthcare Provider Details

I. General information

NPI: 1609927995
Provider Name (Legal Business Name): GLORY MATHEW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BROADWAY
YONKERS NY
10701-1330
US

IV. Provider business mailing address

1010 N BROADWAY
YONKERS NY
10701-1330
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-3535
  • Fax: 914-968-3566
Mailing address:
  • Phone: 914-968-3535
  • Fax: 914-968-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33-334698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: