MEDICARE: LEONARD M. MATTES M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	093836	NY

General Provider Information

NPI Number	:	1023395654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD M. MATTES M.D., P.C.

Provider Business Mailing Address
First Line	:	1199 PARK AVE
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10128-1711
Country	:	US
Telephone Number	:	212-876-7045
Fax Number	:	212-722-3286

Provider Business Practice Location Address
First Line	:	1199 PARK AVE
Second Line	:	SUITE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10128-1711
Country	:	US
Telephone Number	:	212-876-7045
Fax Number	:	212-722-3286

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEONARD M. MATTES
Credential	:	M.D.
Telephone Number	:	212-876-7045

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	11/10/2011

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