Healthcare Provider Details

I. General information

NPI: 1497259824
Provider Name (Legal Business Name): MATTHEW H GAO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST
BAY SHORE NY
11706-8408
US

IV. Provider business mailing address

15 MAJESTIC CT
MANHASSET HILLS NY
11040-1154
US

V. Phone/Fax

Practice location:
  • Phone: 631-968-3000
  • Fax:
Mailing address:
  • Phone: 917-945-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number312661-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: