Provider Demographics
NPI:1447688098
Name:MATHEW, AJIN
Entity type:Individual
Prefix:
First Name:AJIN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:551-497-3927
Mailing Address - Fax:203-346-7974
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-573-9418
Practice Address - Fax:203-346-7974
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant