Provider Demographics
NPI:1982944658
Name:MATHEW, ANNA T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:T
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 COMMUNITY DRIVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-465-8200
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE ROAD
Practice Address - Street 2:LIJMC-DEPARTMENT OF MEDICINE/DIVISION OF NEPHROLOGY
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:341-407-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY267301207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine