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1013822006 NPI number — MATA PSYCHIATRY

NPI Number: 1013822006
Health Care Provider/Practitioner: MATA PSYCHIATRY

Information about “1013822006” NPI (MATA PSYCHIATRY) exists in 1013822006 in HTML format HTML  |  1013822006 in plain Text format TXT  |  1013822006 in PDF (Portable Document Format) PDF  |  1013822006 in an XML format XML  formats.

NPI Number : 1013822006 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013822006",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MATA PSYCHIATRY",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "410 RAMAPO VALLEY RD STE 203B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKLAND",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07436-2716",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-907-7915",
    "MailingAddressFaxNumber": "201-502-4881",
    "FirstLinePracticeLocationAddress": "410 RAMAPO VALLEY RD STE 203B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAKLAND",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07436-2716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-907-7915",
    "PracticeLocationAddressFaxNumber": "201-502-4881",
    "EnumerationDate": "08/17/2026",
    "LastUpdateDate": "08/17/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUBERTO",
    "AuthorizedOfficialFirstName": "VALERIE",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "551-427-0373",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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