MEDICARE: DR. RICHARD JOHN MATTEO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	NY005372	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0022861	OTHER	NY	GHI/MC
2	5372-OB	OTHER	NY	NYS WC
3	P780748	OTHER	NY	OXFORD
4	0905690	OTHER	NY	AETNA/USHC

General Provider Information

NPI Number	:	1013903814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOHN MATTEO DC

Provider Business Mailing Address
First Line	:	12910 23RD AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2710
Country	:	US
Telephone Number	:	718-463-1166
Fax Number	:	718-463-1081

Provider Business Practice Location Address
First Line	:	12910 23RD AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2710
Country	:	US
Telephone Number	:	718-463-1166
Fax Number	:	718-463-1081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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