Provider Demographics
NPI:1811026768
Name:PATERNA, MATTHEW D (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:PATERNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7048
Mailing Address - Country:US
Mailing Address - Phone:203-932-4476
Mailing Address - Fax:203-932-4176
Practice Address - Street 1:16 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-7048
Practice Address - Country:US
Practice Address - Phone:203-932-4476
Practice Address - Fax:203-932-4176
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTV02695Medicare UPIN