Provider Demographics
NPI:1720622467
Name:MATTHEW A. DELMAURO, M.D. PLLC
Entity Type:Organization
Organization Name:MATTHEW A. DELMAURO, M.D. PLLC
Other - Org Name:BODY SCULPTING CENTER OF NYC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:DELMAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-313-6010
Mailing Address - Street 1:2052 31ST ST APT A1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2549
Mailing Address - Country:US
Mailing Address - Phone:513-313-6010
Mailing Address - Fax:
Practice Address - Street 1:590 5TH AVE STE 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4702
Practice Address - Country:US
Practice Address - Phone:212-466-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05794858Medicaid