Individual
ROBERT MIGUEL MATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21725 HEMPSTEAD AVE, QUEENS VILLAGE, NY 11429-1225
(917) 399-9846
Mailing address
20703 PRINCE RANIER PL, LEESBURG, FL 34748
(917) 399-9846
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
641090
NY
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
08/29/2013
Last updated
10/16/2014
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