Basic Information
| Provider Information | |||||||||
| NPI: | 1306188875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | LEENA | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 QUARRYSTONE LN | ||||||||
| Address2: | |||||||||
| City: | MIDDLE ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119531476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136796278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 ALBERTA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155458826 | ||||||||
| FaxNumber: | 9155456975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2013 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080N0001X | BP10047639 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.