Provider Demographics
NPI:1407961758
Name:GEORGE, MATHEW (MD)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 655
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8655
Mailing Address - Country:US
Mailing Address - Phone:585-375-9555
Mailing Address - Fax:585-785-8234
Practice Address - Street 1:61 MARY ST
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1720
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:585-785-8234
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238538208000000X, 208D00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine