=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952459554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH B MATRO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 PEARL ST
-----------------------------------------------------
City | METUCHEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08840-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-494-5207
-----------------------------------------------------
Fax | 908-654-1954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7929 WESTPARK DR APT 1813
-----------------------------------------------------
City | TYSONS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-494-5207
-----------------------------------------------------
Fax | 908-654-1954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MAO33129
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------