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General NPI Number Information
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NPI Number | 1093197295
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Entity Type | Individual
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Provider Name | TERRY MATHEW MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 8916 175TH ST STE CF3
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City | JAMAICA
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State | NY
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Zip | 11432-5557
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Country | US
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Telephone | 718-487-3109
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Fax | 718-487-3081
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Provider Business Mailing Address
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Address Line | 40 HERB HILL RD APT F
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City | GLEN COVE
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State | NY
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Zip | 11542-2833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 296497
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License Number State | NY
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