Provider Demographics
NPI:1649380056
Name:MATTEY, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:MATTEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:E
Other - Last Name:MATTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9190 STOUT RD
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:14847-9707
Mailing Address - Country:US
Mailing Address - Phone:607-532-8826
Mailing Address - Fax:
Practice Address - Street 1:9190 STOUT RD
Practice Address - Street 2:
Practice Address - City:INTERLAKEN
Practice Address - State:NY
Practice Address - Zip Code:14847-9707
Practice Address - Country:US
Practice Address - Phone:607-532-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084015-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03726890Medicaid