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NPI Code Detail

MEDICARE: PREMILA MARIA MATHEWS MD

MEDICARE: PREMILA MARIA MATHEWS MD
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
1207Q00000XFamily Medicine Physician267709NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154556637
Entity Type Code : Individual
Provider Name (Legal Business Name) : PREMILA MARIA MATHEWS MD
Provider Business Mailing Address
First Line : 1894 WALTON AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-6018
Country : US
Telephone Number : 718-583-3060
Fax Number : 718-583-3360
Provider Business Practice Location Address
First Line : 1894 WALTON AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-6018
Country : US
Telephone Number : 718-583-3060
Fax Number : 718-583-3360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2009
Last Update Date : 01/30/2025

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Directions to “ PREMILA MARIA MATHEWS MD” Practice Location

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