Provider Demographics
NPI:1720047350
Name:MATOS-PUENTE, PATRICIA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:MATOS-PUENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PITCH PINE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2755
Mailing Address - Country:US
Mailing Address - Phone:631-754-0765
Mailing Address - Fax:631-963-3214
Practice Address - Street 1:5 PITCH PINE CT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2755
Practice Address - Country:US
Practice Address - Phone:631-754-0765
Practice Address - Fax:631-963-3214
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2014-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165700-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO1269713OtherRAILROAD MEDICARE PIN
NY01306725Medicaid
NYPO1269713OtherRAILROAD MEDICARE PIN
NY47E551Medicare ID - Type UnspecifiedMEDICARE PROVIDER #