Provider Demographics
NPI:1760846539
Name:MATOS, JOSE A JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:MATOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CHESTNUT ST
Mailing Address - Street 2:#4
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1303
Mailing Address - Country:US
Mailing Address - Phone:609-457-8283
Mailing Address - Fax:
Practice Address - Street 1:725 CHESTNUT ST
Practice Address - Street 2:#4
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1303
Practice Address - Country:US
Practice Address - Phone:609-457-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer