Provider Demographics
NPI:1992755607
Name:MATEO, EMERSON MEDRANO (DR PHYSICAL THERAPY)
Entity type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:MEDRANO
Last Name:MATEO
Suffix:
Gender:M
Credentials:DR PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6405
Mailing Address - Country:US
Mailing Address - Phone:212-365-4505
Mailing Address - Fax:
Practice Address - Street 1:453 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6405
Practice Address - Country:US
Practice Address - Phone:212-365-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0249002251G0304X
NJ40QA01048000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics