Provider Demographics
NPI:1629215132
Name:THOMAS J. MATA SSA, P.T., P.C.
Entity Type:Organization
Organization Name:THOMAS J. MATA SSA, P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MATASSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-281-2861
Mailing Address - Street 1:44-27 DOUGLASTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363
Mailing Address - Country:US
Mailing Address - Phone:718-281-2861
Mailing Address - Fax:718-281-0173
Practice Address - Street 1:44-27 DOUGLASTON PARKWAY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363
Practice Address - Country:US
Practice Address - Phone:718-281-2861
Practice Address - Fax:718-281-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012203261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ78782OtherMEDICARE PROVIDER NUMBER
NYQ78781OtherMEDICARE PROVIDER NUMBER