Provider Demographics
NPI:1356509855
Name:POTENZA, MATTHEW VITO (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VITO
Last Name:POTENZA
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 1:2 CROSFIELD AVE STE 204
Mailing Address - Street 2:APT 10F
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2221
Mailing Address - Country:US
Mailing Address - Phone:845-358-6266
Mailing Address - Fax:
Practice Address - Street 1:2 CROSFIELD AVE STE 204
Practice Address - Street 2:APT 10F
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2221
Practice Address - Country:US
Practice Address - Phone:845-358-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237963207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism