DR. DEREK NOEL MATTIMOE (NPI# 1164494613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164494613 |
| Entity Type | Individual |
| Full Name | DR. DEREK NOEL MATTIMOE |
| Credential | MD |
| Practice Address |
2500 Nesconset Hwy Bldg 7d Stony Brook NY 11790-2555 |
| Practice Telephone | 6317513322 |
| Practice Fax Number | 6317513844 |
| Mailing Telephone | 6317513322 |
| Mailing Fax Number | 6317513844 |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 216334 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02068326 | 05 |
| Street Address |
2500 NESCONSET HWY BLDG 7D |
| City | STONY BROOK |
| State | NY |
| Zip Code | 11790-2555 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556025 | Marc Yland | Anesthesiology | 2500 Nesconset Hwy, Bldg 24c, Stony Brook, NY 11790-2598 | 2005-05-27 |
| 1417471202 | Brandon M Henkowicz Dc, P.C. | Chiropractor | 2500 Nesconset Hwy, Stony Brook, NY 11790-2555 | 2017-08-02 |
| 1902345846 | Michael Fama | Physical Therapist | 2500 Nesconset Hwy, Bldg 22b, Stony Brook, NY 11790-2555 | 2017-02-13 |
| 1790149045 | Three Village Orthodontics | Dentist | 2500 Nesconset Hwy, Building 6-b, Stony Brook, NY 11790-2555 | 2016-04-12 |
| 1790156008 | Morgan Smyth | Physician Assistant | 2500 Nesconset Hwy, Stony Brook, NY 11790-2555 | 2015-10-13 |
| 1679964043 | Diana V Carney | Nurse Practitioner | 2500 Nesconset Hwy, Bldg 16, Suite 63, Stony Brook, NY 11790-2555 | 2015-02-06 |
| 1528469442 | Stoney Brook Dental PC | Dentist | 2500 Nesconset Hwy, Suite 11, Stony Brook, NY 11790-2555 | 2014-09-10 |
| 1235545732 | Robert Mosca Physical Therapy, Pllc | Specialist | 2500 Nesconset Hwy, Stony Brook, NY 11790-2555 | 2014-07-03 |
| 1841606605 | Shana Anthony | Physical Therapist | 2500 Nesconset Hwy, Stony Brook, NY 11790-2555 | 2014-07-01 |
| 1891136073 | Comprehensive Neurology of Long Island PC | Neuromusculoskeletal Medicine & OMM | 2500 Nesconset Hwy, Bldg 5b, Stony Brook, NY 11790-2555 | 2013-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649807678 | Ribu Mathew | Student in an Organized Health Care Education/Training Program | Health Science Center T16, Room 020, Stony Brook, NY 11790 | 2020-03-27 |
| 1538794821 | Chaoyang Qu | Student in an Organized Health Care Education/Training Program | 9 Syncamore Dr, Stonybrook, NY 11790 | 2020-03-06 |
| 1457814824 | Brain & Spine Surgery, P.C. | Neurological Surgery | 2500 Nesconset Hwy., Bldg 18c, Stony Brook, NY 11790 | 2019-04-11 |
| 1447759741 | Susan Cuccia | Registered Nurse | 40 Sheppard Lane, Stony Brook, NY 11790 | 2018-02-02 |
| 1972022234 | Carol M Doherty | Specialist | 7 Haskel Lane, Stony Brook, NY 11790 | 2017-09-18 |
| 1972021582 | Louren M Gonzales | Nurse Practitioner | 100 Nicolls Rd Hsc Level 4 Room 120, Hsc Level 4 Room 120, Stony Brook, NY 11790 | 2017-09-04 |
| 1043740954 | Asma Khattak | Behavior Technician | 90 Quaker Path, Stony Brook, NY 11790 | 2017-06-13 |
| 1427452846 | Christina Georgia | Registered Nurse | 36 Ivy League Lane, Stony Brook, NY 11790 | 2014-10-14 |
| 1124361654 | Mandeep Kainth | Student in an Organized Health Care Education/Training Program | Department of Medicine Hsc Level 16, 020, Suny Stony Brook, Stony Brook, NY 11790 | 2013-04-03 |
| 1922357144 | Audry M Luciano | Registered Nurse | 2500 Nesconset Hwy Bldg 23, Stony Brook, NY 11790 | 2012-09-04 |
| Find all providers in zip 11790 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134515299 | Sabina Rebis | Family Medicine | Stony Brook University Hospital Hsc, Hsc 4-050, Stony Brook, NY 11794 | 2015-04-15 |
| 1598856189 | Frederick E Caston | Family Medicine | 7 Alicia Ct, Stony Brook, NY 11790-3380 | 2006-09-27 |
| 1164525457 | Gretchen L Mockler | Family Medicine | Stony Brook Family Medicine, Hsc L4 Room 050, Stony Brook, NY 11794-0001 | 2006-09-05 |
| 1699783548 | Vincent Thomas Geraci | Family Medicine | 1501 Stony Brook Rd, Stony Brook, NY 11790-2212 | 2006-08-04 |
| 1982659470 | Stony Brook Family and Preventive Medicine, University Faculty Practic | Family Medicine | Suny @ Stony Brook, Hsc, L4, Rm 050, Stony Brook, NY 11794-0001 | 2006-05-23 |
| 1033103312 | William James Robbins | Family Medicine | 4 Meadow Dr, Stony Brook, NY 11790-2810 | 2005-09-01 |
| 1114920360 | Kulsoom Shah | Family Medicine | 1 Stadium Rd,student Health Center,stonybrook Univ, Stony Brook, NY 11794-0001 | 2005-05-23 |
| 1083617112 | Sujatha Konnanath Palat | Family Medicine | 1stadium Rd,student Health Service, Stonybrook Univ, Stony Brook, NY 11794-3191 | 2005-05-23 |
| 1790245132 | In Touch With Your Health Medical PC | Family Medicine | 1501 Stony Brook Rd, Stony Brook, NY 11790-2212 | 2019-03-21 |
| 1891217774 | Marisa Massaro | Family Medicine | 207 Hallock Rd, Stony Brook, NY 11790-3033 | 2017-07-12 |
| Find all providers in STONY BROOK | ||||
| City | STONY BROOK |
| Zip Code | 11790 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.