Provider Demographics
NPI:1003937913
Name:DANIEL D. MATHEWS DPM PC
Entity Type:Organization
Organization Name:DANIEL D. MATHEWS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEFAZIO
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-205-6201
Mailing Address - Street 1:4035 95TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-6200
Mailing Address - Country:US
Mailing Address - Phone:718-205-6201
Mailing Address - Fax:718-205-5664
Practice Address - Street 1:4035 95TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-6200
Practice Address - Country:US
Practice Address - Phone:718-205-6201
Practice Address - Fax:718-205-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004379213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G100021789Medicare PIN