Provider Demographics
NPI:1457789299
Name:ANUJA MATHEW, UNKNOWN
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:ANUJA MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANUJA
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 WALL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2201
Mailing Address - Country:US
Mailing Address - Phone:212-742-8000
Mailing Address - Fax:212-742-1557
Practice Address - Street 1:30 WALL ST
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2201
Practice Address - Country:US
Practice Address - Phone:212-742-8000
Practice Address - Fax:212-742-1557
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist