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Individual

NISHA MATHEW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-7993
(203) 276-7020
Mailing address
1 HOSPITAL PLZ, STAMFORD, CT 06902-3602
(203) 276-7993
(203) 276-7020

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
017233
NY
363AS0400X
Surgical Physician Assistant
Primary
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03875725
NY
01
A400101342
MEDICARE PTAN
NY
Enumeration date
03/17/2014
Last updated
02/28/2020
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