Individual
DR. DEREK NOEL MATTIMOE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NESCONSET HWY, BLDG 7D, STONY BROOK, NY 11790-2555
(631) 751-3322
(631) 751-3844
Mailing address
2500 NESCONSET HWY, BLDG 7D, STONY BROOK, NY 11790-2555
(631) 751-3322
(631) 751-3844
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
216334
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02068326
—
NY
Enumeration date
02/07/2006
Last updated
07/09/2007
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