Healthcare Provider Details

I. General information

NPI: 1265352280
Provider Name (Legal Business Name): MATTHEW ANDREW TAMAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11655 QUEENS BLVD STE 216
FOREST HILLS NY
11375-6527
US

IV. Provider business mailing address

7217 5TH AVE APT 1
NORTH BERGEN NJ
07047-4828
US

V. Phone/Fax

Practice location:
  • Phone: 212-804-7659
  • Fax:
Mailing address:
  • Phone: 201-776-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: