Provider Demographics
NPI:1518230481
Name:MATTONE, KELLY O'MALLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:O'MALLEY
Last Name:MATTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8 BOND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2448
Mailing Address - Country:US
Mailing Address - Phone:516-482-2424
Mailing Address - Fax:516-482-2420
Practice Address - Street 1:8 BOND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2448
Practice Address - Country:US
Practice Address - Phone:516-482-2424
Practice Address - Fax:516-482-2420
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183883208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation