Provider Demographics
NPI:1376612937
Name:MATASSA, ANDREW P (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:MATASSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 33RD RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3411
Mailing Address - Country:US
Mailing Address - Phone:718-726-0328
Mailing Address - Fax:718-726-0419
Practice Address - Street 1:2120 33RD RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4286
Practice Address - Country:US
Practice Address - Phone:718-726-0328
Practice Address - Fax:718-726-0419
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007817-1111N00000X
NJ38MC00653300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU59620Medicare UPIN
NJ111304Medicare PIN
NY02741GMedicare PIN