| Doctor Name: | MRS. LISA MATHEW |
| NPI Number: | 1154459634 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 335152 |
| Business Practice Address: | 6845 State Route 434 Apalachin, NY - 137323503 |
| Business Phone Number: | 5167903176 |
| Business Fax Number: | |
| Mailing Address: | 156 Corliss Ave, Apt # 705 JOHNSON CITY |
| State: | NY |
| Postal Code: | 137902060 |
| Phone Number: | 6072175196 |
| Fax Number: | |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 335152 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |