Provider Demographics
NPI:1386832509
Name:MATUSZAK, RICHARD F (RD, LD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:MATUSZAK
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N GRAVEL RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9401
Mailing Address - Country:US
Mailing Address - Phone:585-798-5933
Mailing Address - Fax:
Practice Address - Street 1:223 N GRAVEL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9401
Practice Address - Country:US
Practice Address - Phone:585-798-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered