Provider Demographics
NPI:1174243471
Name:MATHEUS, CARMEL CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:CARMEL
Middle Name:CHRISTINE
Last Name:MATHEUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1328
Mailing Address - Country:US
Mailing Address - Phone:516-323-9676
Mailing Address - Fax:
Practice Address - Street 1:24 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5042
Practice Address - Country:US
Practice Address - Phone:516-293-0051
Practice Address - Fax:516-293-0054
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY848335-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse