Provider Demographics
NPI:1336160019
Name:MATTEL, STEPHEN F (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:MATTEL
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 1:560 WHITE PLAINS ROAD
Mailing Address - Street 2:SUITE 500 - ENTA
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5112
Mailing Address - Country:US
Mailing Address - Phone:914-333-5800
Mailing Address - Fax:914-333-2544
Practice Address - Street 1:1211 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5043
Practice Address - Country:US
Practice Address - Phone:973-633-0808
Practice Address - Fax:973-633-8811
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03913400207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0871907Medicaid
NJP00807443OtherRAILROAD MEDICARE
NJP00807443OtherRAILROAD MEDICARE
NJ177225NEWMedicare PIN