Healthcare Provider Details

I. General information

NPI: 1114964145
Provider Name (Legal Business Name): APOLINARIO B. MATEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 FROST LANE, LAWRENCE NY 11559
LAWRENCE NY
11559
US

IV. Provider business mailing address

48 FROST LANE, LAWRENCE NY 11559
LAWRENCE NY
11559
US

V. Phone/Fax

Practice location:
  • Phone: 516-862-1600
  • Fax:
Mailing address:
  • Phone: 516-862-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number172834-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: