Provider Demographics
NPI:1770840209
Name:COLANTONI, MATTHEW STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:COLANTONI
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:703 MAIN STREET
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503
Mailing Address - Country:US
Mailing Address - Phone:973-754-2240
Mailing Address - Fax:973-754-2249
Practice Address - Street 1:703 MAIN STREET
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2240
Practice Address - Fax:973-754-2249
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY278883207P00000X
NJ25MB10391200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04134396Medicaid