Basic Information
| Provider Information | |||||||||
| NPI: | 1205484680 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MATOS | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 ROUTE 9 N FL 4 | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070951025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018017141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 CEDAR KNOLLS RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR KNOLLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079271621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739988100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2019 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01880600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.