Healthcare Provider Details

I. General information

NPI: 1699451237
Provider Name (Legal Business Name): MARIA ELIZABETH MATTSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E MAIN ST
BAY SHORE NY
11706-8442
US

IV. Provider business mailing address

24 SEABREEZE LN
WEST ISLIP NY
11795-5051
US

V. Phone/Fax

Practice location:
  • Phone: 631-390-7100
  • Fax:
Mailing address:
  • Phone: 631-252-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310944-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: