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General NPI Number Information
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NPI Number | 1962335653
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Entity Type | Individual
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Provider Name | ETHAN MATONE
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Gender | Male
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 2 OHIO DR STE 200
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1111
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Country | US
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Telephone | 516-563-7066
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Fax | 516-563-7067
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Provider Business Mailing Address
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Address Line | 10 PENATAQUIT DR
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City | BRIGHTWATERS
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State | NY
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Zip | 11718-1015
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Country | US
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Telephone | 631-291-0300
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Fax | 631-291-0300
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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 | 163WN0300X
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Taxonomy Name | Nephrology Registered Nurse
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License Number | 91302901
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License Number State | NY
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