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NPI Code Detail

MEDICARE: IRMA M MATOS-RIVERA MD

MEDICARE: IRMA M MATOS-RIVERA MD
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
1208000000XPediatrics Physician149373NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407896590
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRMA M MATOS-RIVERA MD
Provider Business Mailing Address
First Line : 55 WATER STREET
Second Line : 2ND FLOOR CRED DEPT
City : NEW YORK
State : NY
Zip : 10041-0004
Country : US
Telephone Number : 646-680-2888
Fax Number : 516-542-5556
Provider Business Practice Location Address
First Line : 3175 23RD ST
Second Line :
City : ASTORIA
State : NY
Zip : 11106-4134
Country : US
Telephone Number : 718-956-2200
Fax Number : 718-956-2316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 09/20/2019

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Directions to “ IRMA M MATOS-RIVERA MD” Practice Location

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