Provider Demographics
NPI:1316931843
Name:MATUSZ, ROBERT PAUL (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:MATUSZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4037
Mailing Address - Country:US
Mailing Address - Phone:203-728-4714
Mailing Address - Fax:203-729-9046
Practice Address - Street 1:156 MEADOW ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4037
Practice Address - Country:US
Practice Address - Phone:203-728-4714
Practice Address - Fax:203-729-9046
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000121213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004006318Medicaid
030000121CT01OtherBCBS OF CT
T22084Medicare UPIN
1275610001Medicare NSC
480000683Medicare PIN