Provider Demographics
NPI:1922330547
Name:MATERA, MARIA HOPE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:HOPE
Last Name:MATERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERYL LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2801
Mailing Address - Country:US
Mailing Address - Phone:516-456-5979
Mailing Address - Fax:
Practice Address - Street 1:64 DIVISION AVE
Practice Address - Street 2:SUITE 217 C
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2999
Practice Address - Country:US
Practice Address - Phone:516-456-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist