Healthcare Provider Details

I. General information

NPI: 1841288388
Provider Name (Legal Business Name): AYMAN MATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2185
US

IV. Provider business mailing address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2185
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-7272
  • Fax: 845-680-6731
Mailing address:
  • Phone: 845-359-7272
  • Fax: 845-680-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number215965-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number215965-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: