Individual
DR. YESU MATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
675 MAIN STREET, MIDDLETOWN, CT 06457-0645
(860) 347-6971
Mailing address
506 LENOX AVE # MLK17110, NEW YORK, NY 10037-1802
(212) 939-4019
(212) 939-4022
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
64545
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/14/2012
Last updated
01/22/2020
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