Provider Demographics
NPI:1194864728
Name:MATHAI-JOSE, BEENA
Entity type:Individual
Prefix:DR
First Name:BEENA
Middle Name:
Last Name:MATHAI-JOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OPTUM HUNTINGTON PEDIATRICS
Mailing Address - Street 2:205 EAST MAIN STREET, STE 2-8
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-424-1741
Mailing Address - Fax:
Practice Address - Street 1:OPTUM HUNTINGTON PEDIATRICS
Practice Address - Street 2:205 EAST MAIN STREET, STE 2-8
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1101
Practice Address - Country:US
Practice Address - Phone:631-424-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231985208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics