Individual
TIMOTHY D MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MOUNT KISCO MEDICAL GROUP, PC, 90 SOUTH BEDFORD ROAD, MOUNT KISCO, NY 10549-3412
(914) 241-1050
(914) 242-1516
Mailing address
MOUNT KISCO MEDICAL GROUP, PC, 90 SOUTH BEDFORD ROAD, MOUNT KISCO, NY 10549-3412
(914) 241-1050
(914) 242-1516
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
131143
NY
207NS0135X
Procedural Dermatology Physician
Primary
131143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00563933
—
NY
Enumeration date
06/07/2006
Last updated
11/10/2008
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