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Individual

DR. KEVIN R MATHISSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
455 CENTRAL PARK AVE # 317, SCARSDALE, NY 10583-1060
(914) 723-2020
(914) 723-2011
Mailing address
455 CENTRAL PARK AVE STE 317, SCARSDALE, NY 10583-1060
(914) 723-2020
(914) 723-2011

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
198609
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13-4086556
FEDERAL TAX ID#
NY
05
1840404
NY
Enumeration date
06/28/2006
Last updated
02/24/2021
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