Provider Demographics
NPI:1538117221
Name:MATTOO, NIRMAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMAL
Middle Name:K
Last Name:MATTOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2314 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2526
Mailing Address - Country:US
Mailing Address - Phone:347-312-3041
Mailing Address - Fax:718-661-1556
Practice Address - Street 1:6971 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1825
Practice Address - Country:US
Practice Address - Phone:718-507-4400
Practice Address - Fax:718-507-2484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY115880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist