Individual provider Active NPI

Claudine R Mathieu, M.D.

  • Pediatrics Physician
  • Mineola, NY
National Provider Identifier
1679508055
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
209353 Issued in NY
Practice address
77 Jericho Tpke
Mineola, NY 11501-2984
Phone
(516) 216-5910
Fax
(516) 216-5907
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 209353 NY Primary

Addresses

Primary practice location

77 Jericho Tpke
Mineola, NY 11501-2984

Mailing address

77 Jericho Tpke
Mineola, NY 11501-2984
Phone (516) 216-5910

Other identifiers 1

IdentifierTypeStateIssuer
02318656MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130904000186 NY Practitioner - Pediatric Medicine 4880837236 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
209353NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
William F Ryan Community Health Center Inc CurrentSince Jan 7, 2013 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Jan 7, 2013 Accepting new patients
Icahn School of Medicine at Mount Sinai Pediatrics Past Accepting new patients
Happy & Healthy Pediatrics PC Past Accepting new patients
Bayside Pediatric Care P.C. Pediatrics PastSince Jul 1, 2022 Accepting new patients

Locations

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1679508055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012984",
            "telephone_number": "516-216-5910",
            "fax_number": "516-216-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012984",
            "telephone_number": "516-216-5910",
            "fax_number": "516-216-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIEU",
        "first_name": "CLAUDINE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "209353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02318656",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.