Individual
PUTHENPURAKAL K MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1561 LONG POND ROAD, SUITE 401, ROCHESTER, NY 14626
(585) 723-7872
(585) 723-7236
Mailing address
1561 LONG POND ROAD, SUITE 401, ROCHESTER, NY 14626
(585) 723-7872
(585) 723-7236
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
113601
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00458315
—
NY
01
—
1136019WCIMCD
WORKER'S COMPENSATION
—
Enumeration date
05/17/2006
Last updated
07/08/2007
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