Provider Demographics
NPI:1003835083
Name:MATHEW, ANISH PHILIP (PT, MPT (NEURO), DPT)
Entity Type:Individual
Prefix:DR
First Name:ANISH
Middle Name:PHILIP
Last Name:MATHEW
Suffix:
Gender:M
Credentials:PT, MPT (NEURO), DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4132
Mailing Address - Country:US
Mailing Address - Phone:516-385-5685
Mailing Address - Fax:516-616-0943
Practice Address - Street 1:1605 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2603
Practice Address - Country:US
Practice Address - Phone:516-616-0942
Practice Address - Fax:516-616-0943
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283282251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000111562OtherGHI HMO
NY700400OtherACN GROUP
NYXC8401OtherHEALTHNET
NY11609369OtherCAQH