Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 028328 | NY |
NPI | 1003835083 |
---|---|
Provider Name | Dr. Anish Philip Mathew |
First Address | New Hyde Park, NY 11040-4132 |
Second Address | New Hyde Park, NY 11040-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 07/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000111562 | GHI HMO (01) | NY |
11609369 | CAQH (01) | NY |
700400 | ACN GROUP (01) | NY |
XC8401 | HEALTHNET (01) | NY |