Provider Demographics
NPI:1083610125
Name:DEMATTEO, ROBERT ENRICO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ENRICO
Last Name:DEMATTEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 NORTH BROADWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1311
Mailing Address - Country:US
Mailing Address - Phone:914-965-3366
Mailing Address - Fax:914-965-1310
Practice Address - Street 1:970 NORTH BROADWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1311
Practice Address - Country:US
Practice Address - Phone:914-965-3366
Practice Address - Fax:914-965-1310
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173247174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01066435Medicaid
NY01066435Medicaid
NY22E211Medicare ID - Type Unspecified