1841288388 NPI number — DR. AYMAN MATTA MD

Table of content: DR. AYMAN MATTA MD (NPI 1841288388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841288388 NPI number — DR. AYMAN MATTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTA
Provider First Name:
AYMAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841288388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 DUTCH HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10962-2185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-359-7272
Provider Business Mailing Address Fax Number:
845-680-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 DUTCH HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10962-2185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-359-7272
Provider Business Practice Location Address Fax Number:
845-680-6731
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  215965-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 215965-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10059047 . This is a "CDPHP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41206000018 . This is a "FIDELIS ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3302156 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: U70433 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000056446 . This is a "GHI MEDICAID ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 455A61 . This is a "EMPIRE BCBS OF NY ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 215965 . This is a "HIP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3471925 . This is a "AETNA HMO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0498447 . This is a "GHI PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C6549 . This is a "HEALTHNET ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: H20323 . This is a "UPIN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02215396 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7733286 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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