Provider Demographics
NPI:1023301116
Name:MATERA, JOSEPH ANTHONY JR (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:MATERA
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BROWARD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2701
Mailing Address - Country:US
Mailing Address - Phone:845-323-6787
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3525
Practice Address - Country:US
Practice Address - Phone:845-786-2022
Practice Address - Fax:888-786-2098
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034653-1225100000X
CT14.009061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist