Individual
ISAAC I MATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 HARRISON ST, STE 400, JOHNSON CITY, NY 13790
(607) 763-8102
(607) 770-7375
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 729-8156
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
111035
NY
207YS0123X
Facial Plastic Surgery Physician
Primary
111035
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00365233
—
NY
Enumeration date
03/08/2006
Last updated
05/29/2012
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