Provider Demographics
NPI:1285730481
Name:MATHES, EDWARD J (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:MATHES
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-175-2482
Mailing Address - Fax:585-473-5734
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 648
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-785-5000
Practice Address - Fax:585-273-1033
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1682363AM0700X
NY001682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical