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General NPI Number Information
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NPI Number | 1649488842
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Entity Type | Individual
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Provider Name | GLADYS F MATERON PT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 100 NEWBRIDGE RD 8
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City | HICKSVILLE
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State | NY
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Zip | 11801-3963
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Country | US
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Telephone | 516-822-9400
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Fax | 516-822-3418
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Provider Business Mailing Address
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Address Line | 56 WYCKOFF ST
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City | HICKSVILLE
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State | NY
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Zip | 11801-2836
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Country | US
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Telephone | 516-932-0363
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Fax | 513-822-3418
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 014794
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License Number State | NY
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