Provider Demographics
NPI:1487612917
Name:MATTHEWS, JILLIAN J (RPAC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:J
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2061
Mailing Address - Country:US
Mailing Address - Phone:516-437-5600
Mailing Address - Fax:516-437-7428
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2061
Practice Address - Country:US
Practice Address - Phone:516-437-5600
Practice Address - Fax:516-437-7428
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant