Provider Demographics
NPI:1649488842
Name:MATERON, GLADYS F (PT)
Entity type:Individual
Prefix:PROF
First Name:GLADYS
Middle Name:F
Last Name:MATERON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56 WYCKOFF ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2836
Mailing Address - Country:US
Mailing Address - Phone:516-932-0363
Mailing Address - Fax:513-822-3418
Practice Address - Street 1:100 NEWBRIDGE RD
Practice Address - Street 2:8
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3963
Practice Address - Country:US
Practice Address - Phone:516-822-9400
Practice Address - Fax:516-822-3418
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014794OtherLICENSE NUMBER
NY014794OtherLICENSE NUMBER