Basic Information
| Provider Information | |||||||||
| NPI: | 1467626804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CICHON | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S BEDFORD RD | ||||||||
| Address2: | CARE MOUNT MEDICAL PC | ||||||||
| City: | CHAPPAQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105792907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | 1978 CROMPOND RD | ||||||||
| Address2: | CARE MOUNT MEDICAL PC | ||||||||
| City: | CORTLANDT MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105674111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 5684 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 03743597 | 05 | NY | MEDICAID |