Provider Demographics
NPI:1225073356
Name:MATHIEU, PAUL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:MATHIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2388
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2388
Mailing Address - Country:US
Mailing Address - Phone:212-308-1112
Mailing Address - Fax:212-308-1616
Practice Address - Street 1:50 W 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5116
Practice Address - Country:US
Practice Address - Phone:212-579-8558
Practice Address - Fax:212-579-3223
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210417207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959255Medicaid
G94683Medicare UPIN
NY7259088OtherAETNA
NY2021572 07OtherUNITEDHEALTH
NYP2524167OtherOXFORD
NY11635POtherHIP
NY797061Medicare ID - Type UnspecifiedEMPIRE
G94683Medicare UPIN
NY010008903- 01 04OtherAMERICHOICE
NY040426018614OtherFIDELIS
NY11-1948722Other1199NBF
NY01959255Medicaid
NY06285BOtherGHI MEDICARE
NY2591664OtherGHI PPO
NY06285GMedicare PIN