MEDICARE: DR. ROSALIE V MATOS DDS

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	1223P0221X	Pediatric Dentistry	22DI02258700	NJ
2	1223P0221X	Pediatric Dentistry	049870	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1437119146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALIE V MATOS DDS

Provider Business Mailing Address
First Line	:	520 WESTFIELD AVE STE 301
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1658
Country	:	US
Telephone Number	:	908-469-4375
Fax Number	:	908-469-4376

Provider Business Practice Location Address
First Line	:	520 WESTFIELD AVE STE 301
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07208-1658
Country	:	US
Telephone Number	:	908-469-4375
Fax Number	:	908-469-4376

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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