Provider Demographics
NPI:1467427229
Name:MATTONE, MATTHEW (MS,APRN,BC-ANP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MATTONE
Suffix:
Gender:M
Credentials:MS,APRN,BC-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1749
Mailing Address - Country:US
Mailing Address - Phone:631-361-8800
Mailing Address - Fax:631-470-3803
Practice Address - Street 1:100 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1749
Practice Address - Country:US
Practice Address - Phone:631-361-8800
Practice Address - Fax:631-366-3462
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301752-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654355Medicaid
NY02654355Medicaid
NYP23468Medicare UPIN