Provider Demographics
NPI:1265435119
Name:MATEO, ROMEO (MD)
Entity type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:
Last Name:MATEO
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:PO BOX 5801
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5801
Mailing Address - Country:US
Mailing Address - Phone:914-593-7880
Mailing Address - Fax:914-593-7881
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE 700
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-593-7800
Practice Address - Fax:914-593-7881
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2098002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97E633641OtherPTAN
NY01866348Medicaid
NY97E613K221OtherPTAN
NY97E613K223OtherPTAN
NY97E633K222OtherPTAN
NYA400000178OtherPTAN
NY770002077OtherRAIL ROAD MEDICARE
NY97E613K221OtherPTAN
NYA400000178OtherPTAN