Provider Demographics
NPI:1033574439
Name:MUTHRA, NELSON SR (PA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MUTHRA
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:MUTHRA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:30 JUNIPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2104
Mailing Address - Country:US
Mailing Address - Phone:914-941-0108
Mailing Address - Fax:914-941-3331
Practice Address - Street 1:354 HUNTER ST
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5400
Practice Address - Country:US
Practice Address - Phone:914-837-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044551363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical