Provider Demographics
NPI:1053473983
Name:MATO, ANTHONY R (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:MATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1383
Mailing Address - Country:US
Mailing Address - Phone:607-272-5414
Mailing Address - Fax:
Practice Address - Street 1:401 CAYUGA PARK LN STE 300
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1180
Practice Address - Country:US
Practice Address - Phone:607-272-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291581207RX0202X
NJMA76765207RH0003X
PAMD424888207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0166260Medicaid
NJ0166260Medicaid