Basic Information
| Provider Information | |||||||||
| NPI: | 1770840209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLANTONI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 MAIN STREET | ||||||||
| Address2: | EMERGENCY MEDICINE DEPARTMENT | ||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737542240 | ||||||||
| FaxNumber: | 9737542249 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 MAIN STREET | ||||||||
| Address2: | EMERGENCY MEDICINE DEPARTMENT | ||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737542240 | ||||||||
| FaxNumber: | 9737542249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2012 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 278883 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25MB10391200 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04134396 | 05 | NY | MEDICAID |