Mataragas, Kenneth Ryan

Mataragas, Kenneth Ryan is an individual health care provider with primary practice located at 1500 Ny-112 Building 6 Suite C, Port Jefferson Station NY 11776. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Mataragas, Kenneth Ryan can be contacted via phone (631) 732-9090.

Contact Information

Primary practice address
1500 Ny-112 Building 6 Suite C Port Jefferson Station NY 11776
Phone: (631) 732-9090
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1003326133
LBN Legal business name Mataragas, Kenneth Ryan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2017
Last updated Jan 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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