Provider Demographics
NPI:1558762260
Name:MATTHEWS, NORMAN (PA)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SAINT PAULS PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4933
Mailing Address - Country:US
Mailing Address - Phone:718-536-7470
Mailing Address - Fax:914-668-5029
Practice Address - Street 1:678 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8465
Practice Address - Country:US
Practice Address - Phone:718-782-5907
Practice Address - Fax:718-782-5917
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006008-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant