Same | |
13400 Main Rd Mattituck NY 11952-3209 | |
(631) 298-4008 | |
(631) 298-5969 |
Full Name | Same |
---|---|
Speciality | Internal Medicine |
Location | 13400 Main Rd, Mattituck, New York |
Authorized Official Name and Position | Michael O'donnell (CFO) |
Authorized Official Contact | 6312984479 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Same Po Box 2377 Riverhead NY 11901-2108 Ph: (631) 298-4479 | Same 13400 Main Rd Mattituck NY 11952-3209 Ph: (631) 298-4008 |
NPI Number | 1487620613 |
---|---|
Provider Enumeration Date | 02/27/2006 |
Last Update Date | 05/20/2024 |
Medicare PECOS PAC ID | 7113817602 |
---|---|
Medicare Enrollment ID | O20040318000260 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487620613 | NPI | - | NPPES |
01714209 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | John V Celentano |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1558445478 PECOS PAC ID: 7012808975 Enrollment ID: I20040322001133 |
Provider Name | Evan C Nadal |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619946548 PECOS PAC ID: 6103810544 Enrollment ID: I20040409000239 |
Provider Name | Jennifer O Neill |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326147703 PECOS PAC ID: 3779574363 Enrollment ID: I20040521000793 |
Provider Name | David Prentiss |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407852940 PECOS PAC ID: 5890787980 Enrollment ID: I20040527000544 |
Provider Name | Cynthia S Cichanowicz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194892224 PECOS PAC ID: 5597747253 Enrollment ID: I20040605000048 |
Provider Name | Louis Romeo |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1922049089 PECOS PAC ID: 7719960673 Enrollment ID: I20040610001568 |
Provider Name | Eric Shoenfeld |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902984115 PECOS PAC ID: 9335105634 Enrollment ID: I20041208000728 |
Provider Name | Vincent J Leone |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1487667739 PECOS PAC ID: 2466410089 Enrollment ID: I20041229000770 |
Provider Name | Agostino Cervone |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1841206018 PECOS PAC ID: 3476591454 Enrollment ID: I20050421000514 |
Provider Name | Daniel C Massiah |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1063485969 PECOS PAC ID: 1658315627 Enrollment ID: I20050610000855 |
Provider Name | Peter G Sultan |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1346299500 PECOS PAC ID: 1153348198 Enrollment ID: I20051028000311 |
Provider Name | Nathalie B Martinez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467571067 PECOS PAC ID: 3779592035 Enrollment ID: I20060413000527 |
Provider Name | Brian K Mcnulty |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1528047271 PECOS PAC ID: 8022111640 Enrollment ID: I20070319000630 |
Provider Name | Stephen P Ouzounian |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1386615243 PECOS PAC ID: 5890886493 Enrollment ID: I20070811000021 |
Provider Name | Brett E Ruffo |
---|---|
Provider Type | Practitioner - Colorectal Surgery (proctology) |
Provider Identifiers | NPI Number: 1477758274 PECOS PAC ID: 5193817906 Enrollment ID: I20070824000457 |
Provider Name | Fang C Chen |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1255455689 PECOS PAC ID: 2466541578 Enrollment ID: I20071127000570 |
Provider Name | Blaise Napolitano |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1033318449 PECOS PAC ID: 0042309619 Enrollment ID: I20071204000770 |
Provider Name | Luigi Buono |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609816909 PECOS PAC ID: 1456439660 Enrollment ID: I20080428000595 |
Provider Name | Cynthia Carlson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1760449615 PECOS PAC ID: 9032298161 Enrollment ID: I20080430000799 |
Provider Name | Barbara J Farrell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043406424 PECOS PAC ID: 4486724804 Enrollment ID: I20080528000333 |
Provider Name | Richard Kubiak |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1326014556 PECOS PAC ID: 8921032517 Enrollment ID: I20081204000959 |
Provider Name | Manish Chadha |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1992903264 PECOS PAC ID: 1254428626 Enrollment ID: I20090206000565 |
Provider Name | Bogdan Makartchuk |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1982812756 PECOS PAC ID: 2567529142 Enrollment ID: I20090326000071 |
Provider Name | Marc Puchir |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1134132095 PECOS PAC ID: 7719029388 Enrollment ID: I20100120000105 |
Provider Name | Steven Spiegel |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1275509424 PECOS PAC ID: 4981746997 Enrollment ID: I20100128000365 |
Provider Name | Robert D Rubin |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1821282054 PECOS PAC ID: 9739223603 Enrollment ID: I20100216000139 |
Provider Name | Michael Ciminiello |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1528272648 PECOS PAC ID: 7618000670 Enrollment ID: I20100728000870 |
Provider Name | Christine M O Donoghue-kitt |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306039482 PECOS PAC ID: 2264614163 Enrollment ID: I20110315000107 |
Provider Name | David Angelillo |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1497959464 PECOS PAC ID: 7618150699 Enrollment ID: I20110329000646 |
Provider Name | Denise F Dambrosia |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558509828 PECOS PAC ID: 6901076496 Enrollment ID: I20110818000601 |
Provider Name | Amy B Bailey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104158088 PECOS PAC ID: 3173790565 Enrollment ID: I20120126000228 |
Provider Name | Guirlaine Blot-sanon |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1588818504 PECOS PAC ID: 0446417018 Enrollment ID: I20120209000291 |
Provider Name | Heidemarie Grattan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427382456 PECOS PAC ID: 2163680463 Enrollment ID: I20120215000791 |
Provider Name | Maureen Jean Ruga |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255645347 PECOS PAC ID: 7618125279 Enrollment ID: I20120924000759 |
Provider Name | Donna M Baas |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508171646 PECOS PAC ID: 7618120478 Enrollment ID: I20130104000174 |
Provider Name | James L Earl |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780938373 PECOS PAC ID: 4789820127 Enrollment ID: I20130409000621 |
Provider Name | Rajeev B Patel |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1174769996 PECOS PAC ID: 9234368416 Enrollment ID: I20140211000373 |
Provider Name | Janice Np Mcintyre |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366757411 PECOS PAC ID: 7416124151 Enrollment ID: I20140521001730 |
Provider Name | Nazir A Lone |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1912053307 PECOS PAC ID: 4981831682 Enrollment ID: I20141020002472 |
Provider Name | Christina Zaccara |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760672992 PECOS PAC ID: 4082925821 Enrollment ID: I20150619000362 |
Provider Name | Julie Vinod |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861897621 PECOS PAC ID: 2062723638 Enrollment ID: I20150623002688 |
Provider Name | Jean Ann Swartz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043356744 PECOS PAC ID: 1951522655 Enrollment ID: I20151229001467 |
Provider Name | Sara A Cerrone |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1043585276 PECOS PAC ID: 6901108885 Enrollment ID: I20160108002022 |
Provider Name | Joan Becht |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568770238 PECOS PAC ID: 4880987973 Enrollment ID: I20160727001189 |
Provider Name | Jeffrey Tiu |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962840207 PECOS PAC ID: 1456649763 Enrollment ID: I20161019000300 |
Provider Name | Denis J Nankervis |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1205111655 PECOS PAC ID: 5395017453 Enrollment ID: I20170824000333 |
Provider Name | Darya Sterling |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376958850 PECOS PAC ID: 4183997802 Enrollment ID: I20170831001531 |
Provider Name | Victor Olujimi |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1104069160 PECOS PAC ID: 6507130085 Enrollment ID: I20170921002852 |
Provider Name | Kristin S Gordon |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215242326 PECOS PAC ID: 0840588562 Enrollment ID: I20180503002241 |
Provider Name | Tanzia A Chowdhury |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194111708 PECOS PAC ID: 6709141070 Enrollment ID: I20180607002753 |
Provider Name | Jaclyn A Farino |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518486877 PECOS PAC ID: 8628324126 Enrollment ID: I20180712001914 |
Provider Name | Jeselle Dookran |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174910483 PECOS PAC ID: 8527316587 Enrollment ID: I20180807003520 |
Provider Name | Michael Minjun Kim |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891172722 PECOS PAC ID: 1254689276 Enrollment ID: I20180808001681 |
Provider Name | Daniel M Shapiro |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407324478 PECOS PAC ID: 6204173818 Enrollment ID: I20190121000434 |
Provider Name | Nicole C Prianti |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871853473 PECOS PAC ID: 9739421660 Enrollment ID: I20190425000651 |
Provider Name | Janet L Baldasare |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861512485 PECOS PAC ID: 3274876743 Enrollment ID: I20190524000794 |
Provider Name | Kimberly Britt |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245210178 PECOS PAC ID: 1951335363 Enrollment ID: I20190613001707 |
Provider Name | Kristen M Sochol |
---|---|
Provider Type | Practitioner - Hand Surgery |
Provider Identifiers | NPI Number: 1649697004 PECOS PAC ID: 7618205295 Enrollment ID: I20200710001754 |
Provider Name | Cean Mahmud |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1285165134 PECOS PAC ID: 2961748090 Enrollment ID: I20200911002596 |
Provider Name | Lindsey Semprini |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1639529696 PECOS PAC ID: 5496092371 Enrollment ID: I20201113002648 |
Provider Name | Rohit Navlani |
---|---|
Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1245693928 PECOS PAC ID: 4385927334 Enrollment ID: I20210527002847 |
Provider Name | Christopher Blum |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1659735686 PECOS PAC ID: 9234539008 Enrollment ID: I20210616000373 |
Provider Name | Josephine M Champlin |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1851888770 PECOS PAC ID: 8224382593 Enrollment ID: I20210715002559 |
Provider Name | Amar Vyas |
---|---|
Provider Type | Practitioner - Sports Medicine |
Provider Identifiers | NPI Number: 1205323359 PECOS PAC ID: 3577817253 Enrollment ID: I20220819001664 |
Provider Name | Christopher Fecek |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194388124 PECOS PAC ID: 5294061792 Enrollment ID: I20220831000574 |
Provider Name | Kimberly Duffy |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1649731324 PECOS PAC ID: 2769866870 Enrollment ID: I20220908000941 |
Provider Name | Stephanie West |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073247037 PECOS PAC ID: 5991172371 Enrollment ID: I20221028001180 |
Provider Name | Roni Aoun |
---|---|
Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1679147201 PECOS PAC ID: 5193193894 Enrollment ID: I20221201000280 |
Provider Name | Lauren Mclachlan |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164792248 PECOS PAC ID: 9133599574 Enrollment ID: I20221230000112 |
Provider Name | Devashree Parmar |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1831716109 PECOS PAC ID: 7315393857 Enrollment ID: I20231019002827 |
Provider Name | Karina Appel |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1184250151 PECOS PAC ID: 3779939111 Enrollment ID: I20231021000237 |
Provider Name | Kenisha Dania Atwell |
---|---|
Provider Type | Practitioner - Colorectal Surgery (proctology) |
Provider Identifiers | NPI Number: 1508244385 PECOS PAC ID: 9830571637 Enrollment ID: I20231026004040 |
Provider Name | Usman K Naqvi |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1225483092 PECOS PAC ID: 2860737079 Enrollment ID: I20240119002718 |
Mattituck Family Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7555 Main Rd, Mattituck, NY 11952 Phone: 631-298-1678 Fax: 631-298-1679 |