Provider Demographics
NPI:1275880106
Name:IAMMATTEO FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:IAMMATTEO FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENE
Authorized Official - Middle Name:T
Authorized Official - Last Name:IAMMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-421-3997
Mailing Address - Street 1:9 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4115
Mailing Address - Country:US
Mailing Address - Phone:845-421-3997
Mailing Address - Fax:
Practice Address - Street 1:9 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4115
Practice Address - Country:US
Practice Address - Phone:845-421-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008087-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01751091Medicaid
X33651Medicare PIN
NY01751091Medicaid