Mattimoe, Derek Noel

Mattimoe, Derek Noel is an individual health care provider with primary practice located at 2500 Nesconset Hwy Bldg 7D, Stony Brook NY 11790-2555. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Mattimoe, Derek Noel can be contacted via phone (631) 751-3322.

Contact Information

Primary practice address
2500 Nesconset Hwy Bldg 7D Stony Brook NY 11790-2555
Phone: (631) 751-3322
Fax: (631) 751-3844
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 216334 New York

Profile Details

NPI number 1164494613
LBN Legal business name Mattimoe, Derek Noel
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164494613 NPPES
New York MEDICAID 02068326

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