Provider Demographics
NPI:1710258496
Name:PATHROSE, MATHEW (PA)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:PATHROSE
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:53 GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1045
Mailing Address - Country:US
Mailing Address - Phone:917-747-1163
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:SUITE 020
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2013-09-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant