Active NPI
Rani Susan Mathew, D.D.S
- Dentist
- Queens Village, NY
National Provider Identifier
1902951478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 049507
- Practice address
- 20815 Hillside Ave
Queens Village, NY 11427-1711 - Phone
- (718) 468-5300
- Fax
- (718) 301-5832
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 049507 | NY | Primary |
Addresses
Primary practice location
20815 Hillside Ave
Queens Village, NY 11427-1711
Mailing address
20815 Hillside Ave
Queens Village, NY 11427-1711
Phone (718) 468-5300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02321277 | Medicaid | NY |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230606000832 | NY | Order and Referring Only - Other (Non-Physician) | 3375900491 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049507 | NY | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902951478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20815 HILLSIDE AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114271711",
"telephone_number": "718-468-5300",
"fax_number": "718-301-5832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20815 HILLSIDE AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114271711",
"telephone_number": "718-468-5300",
"fax_number": "718-301-5832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "RANI",
"middle_name": "SUSAN",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "049507",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02321277",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Queens Village, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.