Healthcare Provider Details

I. General information

NPI: 1316931843
Provider Name (Legal Business Name): ROBERT PAUL MATUSZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MEADOW ST
NAUGATUCK CT
06770-4037
US

IV. Provider business mailing address

156 MEADOW ST
NAUGATUCK CT
06770-4037
US

V. Phone/Fax

Practice location:
  • Phone: 203-728-4714
  • Fax: 203-729-9046
Mailing address:
  • Phone: 203-728-4714
  • Fax: 203-729-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000121
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: