Healthcare Provider Details

I. General information

NPI: 1629215132
Provider Name (Legal Business Name): THOMAS J. MATA SSA, P.T., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44-27 DOUGLASTON PARKWAY
DOUGLASTON NY
11363
US

IV. Provider business mailing address

44-27 DOUGLASTON PARKWAY
DOUGLASTON NY
11363
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-2861
  • Fax: 718-281-0173
Mailing address:
  • Phone: 718-281-2861
  • Fax: 718-281-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number012203
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS JOSEPH MATASSA
Title or Position: PRESIDENT
Credential: P.T.
Phone: 718-281-2861