MEDICARE: DR. ANISH PHILIP MATHEW PT, MPT (NEURO), DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251N0400X	Neurology Physical Therapist	028328	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000111562	OTHER	NY	GHI HMO
2	700400	OTHER	NY	ACN GROUP
3	XC8401	OTHER	NY	HEALTHNET
4	11609369	OTHER	NY	CAQH

General Provider Information

NPI Number	:	1003835083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANISH PHILIP MATHEW PT, MPT (NEURO), DPT

Provider Business Mailing Address
First Line	:	55 7TH ST
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-4132
Country	:	US
Telephone Number	:	516-385-5685
Fax Number	:	516-616-0943

Provider Business Practice Location Address
First Line	:	1605 HILLSIDE AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2603
Country	:	US
Telephone Number	:	516-616-0942
Fax Number	:	516-616-0943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/07/2012

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Directions to “ DR. ANISH PHILIP MATHEW PT, MPT (NEURO), DPT” Practice Location

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