Provider Demographics
NPI:1922746379
Name:MATOS, ADY JOSEFINA
Entity Type:Individual
Prefix:
First Name:ADY
Middle Name:JOSEFINA
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5204
Mailing Address - Country:US
Mailing Address - Phone:718-536-8620
Mailing Address - Fax:
Practice Address - Street 1:32 LECOUNT PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6416
Practice Address - Country:US
Practice Address - Phone:914-613-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program