Provider Demographics
NPI:1356339139
Name:MATTOO, ANIL (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:
Last Name:MATTOO
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 1:285 SILLS ROAD
Mailing Address - Street 2:BLDG. 7, SUITE B
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-654-4577
Mailing Address - Fax:631-654-3391
Practice Address - Street 1:285 SILLS ROAD
Practice Address - Street 2:BLDG. 7, SUITE B
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-654-4577
Practice Address - Fax:631-654-3391
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003037207RC0200X, 207RP1001X
NV10638207RC0200X, 207RP1001X, 207R00000X
NY258417207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine