Provider Demographics
NPI:1396183133
Name:MATHEW, PHILIP P (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:P
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MORLEY CT
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1138
Mailing Address - Country:US
Mailing Address - Phone:718-701-2727
Mailing Address - Fax:516-874-5784
Practice Address - Street 1:8708 JUSTICE AVE STE CJ
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-8715
Practice Address - Country:US
Practice Address - Phone:718-701-2727
Practice Address - Fax:516-874-5784
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine