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General NPI Number Information
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NPI Number | 1356939110
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Entity Type | Individual
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Provider Name | CHRISTINE MATHEW PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 236 BROADWAY
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City | BROOKLYN
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State | NY
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Zip | 11211-6289
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Country | US
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Telephone | 718-307-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HARKIN LN
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City | HICKSVILLE
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State | NY
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Zip | 11801-5722
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Country | US
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Telephone | 347-387-3671
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025827-01
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License Number State | NY
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