Provider Demographics
NPI:1881141471
Name:WHITCOMB, MATTHEW ALEXANDER (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:WHITCOMB
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST # 325
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-9375
Mailing Address - Fax:212-746-8383
Practice Address - Street 1:525 E 68TH ST # 325
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-9375
Practice Address - Fax:212-746-8383
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant