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General NPI Number Information
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NPI Number | 1033574439
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Entity Type | Individual
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Provider Name | NELSON MUTHRA SR. P.A
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Gender | Male
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 354 HUNTER ST
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City | OSSINING
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State | NY
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Zip | 10562-5400
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Country | US
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Telephone | 914-837-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 30 JUNIPER HILL RD
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City | WHITE PLAINS
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State | NY
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Zip | 10607-2104
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Country | US
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Telephone | 914-941-0108
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Fax | 914-941-3331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0044551
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License Number State | NY
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