Provider Demographics
NPI:1538475314
Name:MEDICAL ARTS OBSTETRICS AND GYNECOLOGY PC
Entity Type:Organization
Organization Name:MEDICAL ARTS OBSTETRICS AND GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATALON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-8226
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8496
Mailing Address - Country:US
Mailing Address - Phone:631-665-8226
Mailing Address - Fax:
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8496
Practice Address - Country:US
Practice Address - Phone:631-665-8226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099639207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty