Provider Demographics
NPI:1912008541
Name:VERDONE, MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:VERDONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ROUTE 25A
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1431
Mailing Address - Country:US
Mailing Address - Phone:631-862-3413
Mailing Address - Fax:631-862-3604
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-862-3413
Practice Address - Fax:631-862-3604
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193835-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574258Medicaid
NY01574258Medicaid
NYA63932Medicare UPIN