Provider Demographics
NPI:1467670661
Name:MATHEW T. CHENGOT MD PC
Entity Type:Organization
Organization Name:MATHEW T. CHENGOT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHENGOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-598-3434
Mailing Address - Street 1:129 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2729
Mailing Address - Country:US
Mailing Address - Phone:631-598-3434
Mailing Address - Fax:631-598-4723
Practice Address - Street 1:129 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2729
Practice Address - Country:US
Practice Address - Phone:631-598-3434
Practice Address - Fax:631-598-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01762716Medicaid
NY00826077Medicaid
NY0133135Medicaid
NY02585784Medicaid
NY01760172Medicaid
NYF27277Medicare UPIN
NY01760172Medicaid
NYB20274Medicare UPIN
NY02585784Medicaid
NY01762716Medicaid
NY00826077Medicaid