MEDICARE: DANIEL MATOS

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	183500000X	Pharmacist	061660-1	NY
2	183500000X	Pharmacist	RP364458	PA

General Provider Information

NPI Number	:	1609325927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MATOS

Provider Business Mailing Address
First Line	:	2636 STATE ROUTE 32
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-8347
Country	:	US
Telephone Number	:	845-562-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 STATE ROUTE 32
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-8347
Country	:	US
Telephone Number	:	845-562-5292
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	11/30/2020

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Directions to “ DANIEL MATOS ” Practice Location

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