Basic Information
| Provider Information | |||||||||
| NPI: | 1427474220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | NISHA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL PLZ | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767993 | ||||||||
| FaxNumber: | 2032767020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL PLZ | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069023602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767993 | ||||||||
| FaxNumber: | 2032767020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 017233 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 03875725 | 05 | NY | MEDICAID | A400101342 | 01 | NY | MEDICARE PTAN | OTHER |