Provider Demographics
NPI:1679517643
Name:GUY, MATTHEW JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOEL
Last Name:GUY
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 1:14404 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1141
Mailing Address - Country:US
Mailing Address - Phone:718-945-2714
Mailing Address - Fax:
Practice Address - Street 1:14404 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1141
Practice Address - Country:US
Practice Address - Phone:718-945-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108805207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17131Medicare UPIN