Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 004379 | NY |
NPI | 1184731739 |
---|---|
Provider Name | Dr. Daniel De Fazio Mathews |
First Address | Great Neck, NY 11021-3345 |
Second Address | Elmhurst, NY 11373-6200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006469 | (02) | NY |