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General NPI Number Information
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NPI Number | 1417247883
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Entity Type | Organization
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Legal Business Name | RTM PHYSIATRY AND PSYCHIATRY PLLC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 03/08/2015
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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 | 2430 W 3RD ST
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City | BROOKLYN
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State | NY
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Zip | 11223-5930
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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 | OWNER
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Name | THRESIAMMA MATHEW
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Credential | MD
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Telephone | 718-646-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 247349
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License Number State | NY
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