Provider Demographics
NPI:1245222025
Name:MATKOVIC, CHRISTOPHER S (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:MATKOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MAPLE AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3520
Mailing Address - Country:US
Mailing Address - Phone:631-265-0075
Mailing Address - Fax:631-265-0078
Practice Address - Street 1:80 MAPLE AVE
Practice Address - Street 2:STE 204
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3520
Practice Address - Country:US
Practice Address - Phone:631-265-0075
Practice Address - Fax:631-265-0078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137370207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00557704Medicaid
NYP485065OtherOXFORD
B04873Medicare UPIN
NY00557704Medicaid