Provider Demographics
NPI:1487880860
Name:EXCEPTIONAL MOBILE LLC
Entity type:Organization
Organization Name:EXCEPTIONAL MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATADEEN-ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-557-8952
Mailing Address - Street 1:41 POINT ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2246
Mailing Address - Country:US
Mailing Address - Phone:646-702-5087
Mailing Address - Fax:
Practice Address - Street 1:41 POINT ST APT SUITE1B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2245
Practice Address - Country:US
Practice Address - Phone:646-702-5087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426885207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty