Active NPI
Robert Miguel Matos
- Developmental Therapist
- Queens Village, NY
National Provider Identifier
1225462906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 21725 Hempstead Ave
Queens Village, NY 11429-1225 - Phone
- (917) 399-9846
- NPI assigned
- Aug 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 641090 | NY | |
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
21725 Hempstead Ave
Queens Village, NY 11429-1225
Mailing address
20703 Prince Ranier PL
Leesburg, FL 34748
Phone (917) 399-9846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 641090 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413417600000",
"number": "1225462906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20703 PRINCE RANIER PL",
"city": "LEESBURG",
"state": "FL",
"postal_code": "34748",
"telephone_number": "917-399-9846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21725 HEMPSTEAD AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114291225",
"telephone_number": "917-399-9846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATOS",
"first_name": "ROBERT",
"middle_name": "MIGUEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-29",
"last_updated": "2014-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "641090",
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queens Village, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.