Individual
DIANA MATARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
Mailing address
1875 WISTERIA CIR, BELLPORT, NY 11713-3060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022827
NY
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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