Provider Demographics
NPI:1629167176
Name:MATANO, RICHARD ANTHONY (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MATANO
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:1010 NORTHERN BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-883-0700
Mailing Address - Fax:516-883-8194
Practice Address - Street 1:1010 NORTHERN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-883-0700
Practice Address - Fax:516-883-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY166525174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2811628OtherAETNA US HEALTHCARE HMO
NY29020POtherHIP
NY11-3547376OtherBEECHSTREET
NY46P542OtherBLUE CROSS/BLUE SHIELD
NY01392841Medicaid
NY11-3457376OtherISLAND GROUP ADMINISTRATO
NYAA50269COtherMDNY
NYP413776OtherOXFORD HEALTHPLANS
NY113547376-01Other1199
NY113547376OtherUNITED HEALTHCARE EMPIRE
NY4254565OtherAETNA US HEALTHCARE PPO
NY4C2374OtherHEALTH NET
NY11-3547376OtherMULTIPLAN
NY113547376OtherUNITED HEALTHCARE
NY9684796OtherGHI
NY0508249007OtherCIGNA
NY113547376OtherHORIZON HEALTHCARE
NY770003087OtherRAILROAD MEDICARE
NY113547376OtherUNITED HEALTHCARE EMPIRE
NY01392841Medicaid