Healthcare Provider Details

I. General information

NPI: 1730230087
Provider Name (Legal Business Name): JANET E MATHEWS P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 S HAMILTON ST STE 109
PAINTED POST NY
14870-9705
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-2089
  • Fax: 607-936-8176
Mailing address:
  • Phone: 607-271-2050
  • Fax: 607-873-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: