Provider Demographics
NPI:1992943732
Name:MATHEW, SUNITA A (DDS)
Entity type:Individual
Prefix:MS
First Name:SUNITA
Middle Name:A
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1023
Mailing Address - Country:US
Mailing Address - Phone:516-741-0617
Mailing Address - Fax:
Practice Address - Street 1:2001 MARCUS AVE STE S60
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1040
Practice Address - Country:US
Practice Address - Phone:516-354-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice