Provider Demographics
NPI:1467524975
Name:MATA, ARMANDO BERNABE (MD)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:BERNABE
Last Name:MATA
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 1:161 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-729-0101
Mailing Address - Fax:607-729-5693
Practice Address - Street 1:161 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-729-0101
Practice Address - Fax:607-729-5693
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1341801208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00735222Medicaid
198012OtherMVP
C58638Medicare UPIN