Provider Demographics
NPI:1104250653
Name:MATHEW, ANTONY (CO,BOCPO)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:CO,BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SMART AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1066
Mailing Address - Country:US
Mailing Address - Phone:914-968-1370
Mailing Address - Fax:914-968-1371
Practice Address - Street 1:70 SMART AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1066
Practice Address - Country:US
Practice Address - Phone:914-968-1370
Practice Address - Fax:914-968-1371
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC14290222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist