Provider Demographics
NPI:1437119146
Name:MATOS, ROSALIE V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:V
Last Name:MATOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WESTFIELD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1658
Mailing Address - Country:US
Mailing Address - Phone:908-469-4375
Mailing Address - Fax:908-469-4376
Practice Address - Street 1:520 WESTFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1658
Practice Address - Country:US
Practice Address - Phone:908-469-4375
Practice Address - Fax:908-469-4376
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022587001223P0221X
NY0498701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02420368Medicaid