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General NPI Number Information
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NPI Number | 1235933466
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Entity Type | Individual
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Provider Name | MATHEW ROGIN ITTEERA MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 169 RIVERSIDE DRIVE GME OFFICES
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City | BINGHAMTON
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State | NY
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Zip | 13905
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Country | US
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Telephone | 607-722-2769
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Fax | 607-798-5069
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Provider Business Mailing Address
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Address Line | 7333 GRAND AVE APT 102
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4115
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Country | US
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Telephone | 630-234-4439
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Fax | 208-203-1015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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