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General NPI Number Information
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NPI Number | 1548058530
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Entity Type | Individual
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Provider Name | JERIN JOSE MATHEW
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Gender | Male
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 140 OLD ORANGEBURG RD
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City | ORANGEBURG
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State | NY
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Zip | 10962-1157
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Country | US
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Telephone | 845-680-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 800A BROOKRIDGE DR APT 82
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-1891
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Country | US
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Telephone | 845-689-7261
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 943485
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License Number State | NY
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