NPI 1417310764 · live from the CMS NPI Registry
Justin Itty Mathew, M.D., M.L.S.
Internal Medicine, Hospice and Palliative Medicine in Albuquerque, NM. National Provider Identifier 1417310764, active.
NPI record
| NPI | 1417310764 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Hospice and Palliative Medicine 207RH0002X |
| Practice location | 1 University Of New Mexico, Msc10 5550, Albuquerque, NM 87131 |
| Practice phone | 505-272-4661 |
| Mailing address | 800 Bradbury Dr Se Ste 116, Albuquerque, NM 87106 |
| Enumerated | April 4, 2016 |
| Last updated | August 13, 2025 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MD2018-0609 (NM) |
| Internal Medicine, Hospice and Palliative Medicine primary | 207RH0002X | MD02018-0609 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.