Provider Demographics
NPI:1750671962
Name:PADIYEDATHU, JULIA MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MATHEW
Last Name:PADIYEDATHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:310 E 14TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-505-6550
Mailing Address - Fax:212-979-1772
Practice Address - Street 1:140 EXECUTIVE DR
Practice Address - Street 2:STE 300
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5509
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:845-562-0147
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY266235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400124457Medicare PIN