Most Relevant Information
Provider Data
| NPI Number: | 1003326133 |
| Provider Name: | KENNETH RYAN MATARAGAS PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/03/2017 |
| Last Updated: | 01/17/2024 |
Provider Practice Location
1500 NY-112 BUILDING 6
SUITE C
PORT JEFFERSON STATION
NY
11776
Practice Location Phone/Fax
| Phone: | 6317329090 |
| Fax: |
Provider Mailing Location
1500 NY-112
BUILDING 6 SUITE C
PORT JEFFERSON STATION
NY
11776
Provider Mailing Phone/Fax
| Phone: | 6317329090 |
| Fax: |