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General NPI Number Information
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NPI Number | 1538475314
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS OBSTETRICS AND GYNECOLOGY PC
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 375 E MAIN ST SUITE 4
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City | BAY SHORE
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State | NY
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Zip | 11706-8496
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Country | US
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Telephone | 631-665-8226
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Fax |
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Provider Business Mailing Address
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Address Line | 375 E MAIN ST SUITE 4
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City | BAY SHORE
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State | NY
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Zip | 11706-8496
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Country | US
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Telephone | 631-665-8226
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN MATALON
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Credential | MD
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Telephone | 631-665-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 099639
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License Number State | NY
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