Matthew R Tiede I, PA-C
Physician Assistant, Medical in New York, NY. Individual provider (NPI-1).
NPI number1235304536
StatusActive
Last updated in NPPESApr 28, 2008
Details
- NPI
- 1235304536
- Entity type
- Individual (NPI-1)
- Name
- Matthew R Tiede I
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 28, 2008
- Last updated
- Apr 28, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | – | – | Yes |
Practice location
525 E 68th StBox 130, Rm M-528
New York, NY 10065-4870
Phone 610-716-1687
Mailing address
537 S Waterloo RdDevon, PA 19333-1729
Phone 610-716-1687
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