Provider Demographics
NPI:1578759049
Name:ANDREW C. MATTELIANO, M.D.
Entity Type:Organization
Organization Name:ANDREW C. MATTELIANO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTELIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-0726
Mailing Address - Street 1:235 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1435
Mailing Address - Country:US
Mailing Address - Phone:716-882-0726
Mailing Address - Fax:716-882-3484
Practice Address - Street 1:235 NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1435
Practice Address - Country:US
Practice Address - Phone:716-882-0726
Practice Address - Fax:716-882-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1598681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP77759Medicare UPIN
NYB71418Medicare UPIN