Provider Demographics
NPI:1184703407
Name:MATEY, MARSHA L (CRNA)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:MATEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 SENECA ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3565
Mailing Address - Country:US
Mailing Address - Phone:716-674-8189
Mailing Address - Fax:716-712-0469
Practice Address - Street 1:4185 SENECA ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3565
Practice Address - Country:US
Practice Address - Phone:716-674-8189
Practice Address - Fax:716-712-0469
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362500-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5065Medicare ID - Type Unspecified
NYP51141Medicare UPIN