MEDICARE: MATTEO CHIROPRACTIC & PHYSICAL THERAPY PLLC

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	111N00000X	Chiropractor	5372	NY

General Provider Information

NPI Number	:	1922348598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTEO CHIROPRACTIC & PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	12910 23RD AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2710
Country	:	US
Telephone Number	:	718-463-1166
Fax Number	:	718-463-1081

Provider Business Practice Location Address
First Line	:	12910 23RD AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-2710
Country	:	US
Telephone Number	:	718-463-1166
Fax Number	:	718-463-1081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD MATTEO
Credential	:	D.C.
Telephone Number	:	718-463-1166

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	02/19/2013

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