Provider Demographics
NPI:1033306907
Name:PASQUALE J. DEMATTEO, D.O., P.C.
Entity type:Organization
Organization Name:PASQUALE J. DEMATTEO, D.O., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-384-2273
Mailing Address - Street 1:525 TUNXIS HILL CUT OFF
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4447
Mailing Address - Country:US
Mailing Address - Phone:203-384-2273
Mailing Address - Fax:203-384-1235
Practice Address - Street 1:525 TUNXIS HILL CUT OFF
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4447
Practice Address - Country:US
Practice Address - Phone:203-384-2273
Practice Address - Fax:203-384-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000-200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01368Medicare PIN