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General NPI Number Information
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NPI Number | 1558301861
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Entity Type | Individual
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Provider Name | TIMOTHY D MATTISON MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | MOUNT KISCO MEDICAL GROUP, PC 90 SOUTH BEDFORD ROAD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3412
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Country | US
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Telephone | 914-241-1050
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Fax | 914-242-1516
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Provider Business Mailing Address
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Address Line | MOUNT KISCO MEDICAL GROUP, PC 90 SOUTH BEDFORD ROAD
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3412
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Country | US
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Telephone | 914-241-1050
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Fax | 914-242-1516
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 131143
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 131143
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License Number State | NY
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