Provider Demographics
NPI:1083895635
Name:MATTERS, BRUCE C
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:C
Last Name:MATTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-0633
Mailing Address - Country:US
Mailing Address - Phone:800-477-0743
Mailing Address - Fax:631-907-2552
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3307
Practice Address - Country:US
Practice Address - Phone:800-477-0743
Practice Address - Fax:631-907-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)