Provider Demographics
NPI:1841288388
Name:MATTA, AYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:
Last Name:MATTA
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 1:99 DUTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2185
Mailing Address - Country:US
Mailing Address - Phone:845-359-7272
Mailing Address - Fax:845-680-6731
Practice Address - Street 1:99 DUTCH HILL RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2185
Practice Address - Country:US
Practice Address - Phone:845-359-7272
Practice Address - Fax:845-680-6731
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215965-1174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10059047OtherCDPHP ID #
NY41206000018OtherFIDELIS ID #
NYP3302156OtherOXFORD ID #
NYU70433OtherAMERIHEALTH ADMINISTRATOR
NY000000056446OtherGHI MEDICAID ID #
NY455A61OtherEMPIRE BCBS OF NY ID #
NY215965OtherHIP ID #
NY3471925OtherAETNA HMO ID #
NY0498447OtherGHI PPO ID #
NY3C6549OtherHEALTHNET ID #
NYH20323OtherUPIN #
NY02215396Medicaid
NY7733286OtherAETNA PPO ID #
NY455A61Medicare ID - Type UnspecifiedMEDICARE NY ID #