Provider Demographics
NPI:1265299044
Name:CITY MEDICAL PHYSICIAN PC
Entity type:Organization
Organization Name:CITY MEDICAL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-652-0151
Mailing Address - Street 1:99 DUTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2185
Mailing Address - Country:US
Mailing Address - Phone:845-359-7272
Mailing Address - Fax:845-359-7388
Practice Address - Street 1:417 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3004
Practice Address - Country:US
Practice Address - Phone:845-359-7272
Practice Address - Fax:845-359-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty