Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 008360-1 | NY |
NPI | 1861838575 |
---|---|
Provider Name | Prof. Felicia Mateo I |
First Address | Bronx, NY 10469-4206 |
Second Address | Bronx, NY 10469-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |