Individual
THOR MATAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPOA
Contact information
Practice address
2612 LINCONIA AVE, TREVOSE, PA 19053-6736
(267) 980-7415
(215) 638-2119
Mailing address
2612 LINCONIA AVE, TREVOSE, PA 19053-6736
(267) 980-7415
(215) 638-2119
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
45AB00000400
NJ
Other
Enumeration date
04/08/2016
Last updated
04/08/2016
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