Provider Demographics
NPI:1144475476
Name:MATTHEWS, VIRGINIA (MSED)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4029
Mailing Address - Country:US
Mailing Address - Phone:718-810-9882
Mailing Address - Fax:516-561-4222
Practice Address - Street 1:75 REGENT ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:718-810-9882
Practice Address - Fax:516-561-4222
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist