Healthcare Provider Details

I. General information

NPI: 1336160019
Provider Name (Legal Business Name): STEPHEN F MATTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 HAMBURG TPKE
WAYNE NJ
07470-5043
US

IV. Provider business mailing address

560 WHITE PLAINS ROAD SUITE 500 - ENTA
TARRYTOWN NY
10591-5112
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-0808
  • Fax: 973-633-8811
Mailing address:
  • Phone: 914-333-5800
  • Fax: 914-333-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA03913400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: