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General NPI Number Information
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NPI Number | 1548249378
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Entity Type | Individual
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Provider Name | MARTIN MATALON MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 11/30/2016
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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 | 11706-8418
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Country | US
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Telephone | 631-665-8226
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Fax | 631-665-8140
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Provider Business Mailing Address
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Address Line | 1223 MONTAUK HWY STE B
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City | OAKDALE
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State | NY
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Zip | 11769-1491
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Country | US
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Telephone | 631-665-8226
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Fax | 631-665-8140
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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 | 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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