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General NPI Number Information
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NPI Number | 1467670661
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Entity Type | Organization
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Legal Business Name | MATHEW T. CHENGOT MD PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 129 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2729
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Country | US
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Telephone | 631-598-3434
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Fax | 631-598-4723
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Provider Business Mailing Address
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Address Line | 129 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2729
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Country | US
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Telephone | 631-598-3434
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Fax | 631-598-4723
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATHEW THOMAS CHENGOT
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Credential | M.D.
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Telephone | 631-598-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 148679
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License Number State | NY
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