1730529272 NPI number — MS. FRIDA INDIANA MATUTE M.A. CCC-SLP

Table of content: MS. FRIDA INDIANA MATUTE M.A. CCC-SLP (NPI 1730529272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730529272 NPI number — MS. FRIDA INDIANA MATUTE M.A. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATUTE
Provider First Name:
FRIDA
Provider Middle Name:
INDIANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730529272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 FIFTH AVENUE
Provider Second Line Business Mailing Address:
SUITE 521
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-5012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-960-3730
Provider Business Mailing Address Fax Number:
888-807-7794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 521
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-7603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-960-3730
Provider Business Practice Location Address Fax Number:
888-807-7794
Provider Enumeration Date:
06/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  021181-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 12150081 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com