Healthcare Provider Details

I. General information

NPI: 1013903814
Provider Name (Legal Business Name): RICHARD JOHN MATTEO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 23RD AVE
COLLEGE POINT NY
11356-2710
US

IV. Provider business mailing address

12910 23RD AVE
COLLEGE POINT NY
11356-2710
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-1166
  • Fax: 718-463-1081
Mailing address:
  • Phone: 718-463-1166
  • Fax: 718-463-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberNY005372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: