Healthcare Provider Details

I. General information

NPI: 1548214331
Provider Name (Legal Business Name): JEFFREY AARON MATOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 3RD AVE
NEW YORK NY
10028-1802
US

IV. Provider business mailing address

1421 3RD AVE
NEW YORK NY
10028-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-6384
  • Fax: 212-772-1674
Mailing address:
  • Phone: 212-772-6384
  • Fax: 212-772-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number142410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: