Provider Demographics
NPI:1851623102
Name:MATUSZAK, EVA ANNE (MS)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:ANNE
Last Name:MATUSZAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4700
Mailing Address - Country:US
Mailing Address - Phone:516-705-4362
Mailing Address - Fax:
Practice Address - Street 1:96 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4700
Practice Address - Country:US
Practice Address - Phone:516-705-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist