Provider Demographics
NPI:1700195351
Name:SALIM A MATAR MD PC
Entity Type:Organization
Organization Name:SALIM A MATAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-928-7750
Mailing Address - Street 1:640 BELLE TERRE RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1936
Mailing Address - Country:US
Mailing Address - Phone:631-928-7750
Mailing Address - Fax:631-928-7867
Practice Address - Street 1:640 BELLE TERRE RD
Practice Address - Street 2:BUILDING C
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1936
Practice Address - Country:US
Practice Address - Phone:631-928-7750
Practice Address - Fax:631-928-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191264207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF01543Medicare UPIN
NY33H371Medicare PIN