Provider Demographics
NPI:1982026928
Name:MATA, MARTA RAMONA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:RAMONA
Last Name:MATA
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 1:19207 42ND AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2901
Mailing Address - Country:US
Mailing Address - Phone:917-681-6759
Mailing Address - Fax:
Practice Address - Street 1:9825 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4627
Practice Address - Country:US
Practice Address - Phone:718-271-5637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator