Provider Demographics
NPI:1437794187
Name:MATRIX MEDICAL WOUND CARE PLLC
Entity Type:Organization
Organization Name:MATRIX MEDICAL WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-300-0797
Mailing Address - Street 1:234 ORINOCO DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1822
Mailing Address - Country:US
Mailing Address - Phone:631-300-0797
Mailing Address - Fax:631-647-8429
Practice Address - Street 1:234 ORINOCO DR
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1822
Practice Address - Country:US
Practice Address - Phone:631-300-0797
Practice Address - Fax:631-647-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty