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General NPI Number Information
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NPI Number | 1053146340
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Entity Type | Individual
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Provider Name | MATTHEW JOHN QUIROZ
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Gender | Male
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 22 W COLUMBIA ST
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City | HEMPSTEAD
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State | NY
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Zip | 11550-2411
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Country | US
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Telephone | 516-331-1587
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Fax | 516-216-4231
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Provider Business Mailing Address
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Address Line | 47 ROBIN DR
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City | HAUPPAUGE
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State | NY
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Zip | 11788-1104
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Country | US
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Telephone | 631-335-7510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 003769
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License Number State | NY
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