Provider Demographics
NPI:1366574071
Name:MATTHEWS, KATHERINE L (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:152 NORTH WELLWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-226-4342
Mailing Address - Fax:631-991-4001
Practice Address - Street 1:152 NORTH WELLWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-226-4342
Practice Address - Fax:631-991-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60974Medicare UPIN