MEDICARE: ALBERT R MATUZA D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	042099-1	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	:	1619171386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT R MATUZA D.D.S.

Provider Business Mailing Address
First Line	:	78 MARION AVE
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-3219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8710 GRAND AVE
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4444
Country	:	US
Telephone Number	:	718-429-8300
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	12/26/2013

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