Basic Information
| Provider Information | |||||||||
| NPI: | 1760443394 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MATUT | ||||||||
| FirstName: | JAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WESTCHESTER AVE STE N715 | ||||||||
| Address2: | |||||||||
| City: | RYE BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105731369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146075730 | ||||||||
| FaxNumber: | 9144571195 | ||||||||
| Practice Location | |||||||||
| Address1: | 73 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107107616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148316830 | ||||||||
| FaxNumber: | 9148316831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 054294 | CT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0000X | 201576 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 01936965 | 05 | NY | MEDICAID |