Provider Demographics
NPI:1285801886
Name:MATHEW, MARIYAM BINDU K (DC)
Entity type:Individual
Prefix:DR
First Name:MARIYAM BINDU
Middle Name:K
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W NYACK RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2240
Mailing Address - Country:US
Mailing Address - Phone:845-535-3643
Mailing Address - Fax:845-535-3644
Practice Address - Street 1:719 W NYACK RD
Practice Address - Street 2:SUITE 21
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2241
Practice Address - Country:US
Practice Address - Phone:845-535-3643
Practice Address - Fax:845-535-3644
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor