Healthcare Provider Details

I. General information

NPI: 1619144466
Provider Name (Legal Business Name): MATTHEW FRANK TITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL DEPT ANESTHESIOLOGY - HSC4 #60
STONY BROOK NY
11794-8480
US

IV. Provider business mailing address

STONY BROOK UNIVERSITY HOSPITAL DEPARTMENT OF ANESTHESIOLOGY
STONY BROOK NY
11794-8480
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax: 631-444-2907
Mailing address:
  • Phone: 631-444-2975
  • Fax: 631-444-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number249978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: