Provider Demographics
NPI:1922140680
Name:MATUSIAK, DONNA RILEY (MA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RILEY
Last Name:MATUSIAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 OLD COUNTRY RD STE 308
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5119
Mailing Address - Country:US
Mailing Address - Phone:516-457-4143
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD COUNTRY RD STE 308
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5119
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:516-627-3222
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist