Mathew, Jacob K

Mathew, Jacob K is an sole proprietor health care provider with primary practice located at 100 Oakland Ave Suite 4, Port Jefferson NY 11777-2172. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Mathew, Jacob K can be contacted via phone (631) 476-4780.

Contact Information

Primary practice address
100 Oakland Ave Suite 4 Port Jefferson NY 11777-2172
Phone: (631) 476-4780
Fax: (631) 476-4781
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 196027 New York

Profile Details

NPI number 1407857634
LBN Legal business name Mathew, Jacob K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2005
Last updated Oct 15th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407857634 NPPES
New York MEDICAID 01494779

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