Provider Demographics
NPI:1205042330
Name:HELEN MATE DPM
Entity Type:Organization
Organization Name:HELEN MATE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-767-1000
Mailing Address - Street 1:1648 TAYLOR RD
Mailing Address - Street 2:#157
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128
Mailing Address - Country:US
Mailing Address - Phone:386-767-1000
Mailing Address - Fax:386-767-1001
Practice Address - Street 1:4770 RIDGEWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-767-1000
Practice Address - Fax:386-767-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2340213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU36223Medicare UPIN
FLU0245Medicare PIN
3975110001Medicare NSC