Individual
GREG MATUKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24180 COUNTY ROUTE 16, EVANS MILLS, NY 13637-3127
(315) 629-4441
(315) 629-5473
Mailing address
595 W MAIN ST, WATERTOWN, NY 13601-1335
(315) 788-1530
(315) 788-3794
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02921011
—
NY
Enumeration date
08/27/2008
Last updated
08/27/2008
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