Provider Demographics
NPI:1306381397
Name:MATHEW, VINCY MARY (ANP)
Entity Type:Individual
Prefix:MS
First Name:VINCY
Middle Name:MARY
Last Name:MATHEW
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W 170TH ST
Mailing Address - Street 2:APT 2I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2954
Mailing Address - Country:US
Mailing Address - Phone:212-568-6399
Mailing Address - Fax:
Practice Address - Street 1:720 W 170TH ST
Practice Address - Street 2:APT 2I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2954
Practice Address - Country:US
Practice Address - Phone:212-568-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307560-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health