Provider Demographics
NPI:1619187051
Name:MATEO-BERMUDEZ, JOSE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:MATEO-BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 JOHN F KENNEDY BLVD
Mailing Address - Street 2:APT 1907
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1440
Mailing Address - Country:US
Mailing Address - Phone:215-575-0730
Mailing Address - Fax:
Practice Address - Street 1:1900 JOHN F KENNEDY BLVD
Practice Address - Street 2:APT 1907
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1440
Practice Address - Country:US
Practice Address - Phone:215-575-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138172084P0800X
PAMD037962E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry