MEDICARE: MILAGROS MATOS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	26NP07375300	NJ

General Provider Information

NPI Number	:	1376233965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILAGROS MATOS LPN

Provider Business Mailing Address
First Line	:	3333 PARK AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5913
Country	:	US
Telephone Number	:	201-558-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 PARK AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5913
Country	:	US
Telephone Number	:	201-558-0094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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Directions to “ MILAGROS MATOS LPN” Practice Location

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