Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 097089 | NY |
NPI | 1053734038 |
---|---|
Provider Name | Dr. Marvin Israel Matz |
First Address | Rye Brook, NY 10573 |
Second Address | Rye Brook, NY 10573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2014 |
Last Update Date | 28/01/2014 |