Provider Demographics
NPI:1609953405
Name:DIMATTEO, VITO ELISEO (DC)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:ELISEO
Last Name:DIMATTEO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MAMARONECK AVE
Mailing Address - Street 2:SUITE102
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1900
Mailing Address - Country:US
Mailing Address - Phone:914-381-7575
Mailing Address - Fax:914-381-7578
Practice Address - Street 1:875 MAMARONECK AVE
Practice Address - Street 2:SUITE102
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1900
Practice Address - Country:US
Practice Address - Phone:914-381-7575
Practice Address - Fax:914-381-7578
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010707-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU9816Medicare UPIN