Provider Demographics
NPI:1235247453
Name:FEE, MATTHEW JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:FEE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3203
Mailing Address - Country:US
Mailing Address - Phone:631-864-7100
Mailing Address - Fax:631-864-7129
Practice Address - Street 1:989 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3203
Practice Address - Country:US
Practice Address - Phone:631-864-7100
Practice Address - Fax:631-864-7129
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476894367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00106083OtherRR MEDICARE
P00106083OtherRR MEDICARE
NYR0B751Medicare ID - Type Unspecified