| Doctor Name: | THOR MATAYA |
| NPI Number: | 1700240470 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPOA |
| License Number: | 45AB00000400 |
| Business Practice Address: | 2612 Linconia Ave Trevose, PA - 190536736 |
| Business Phone Number: | 2679807415 |
| Business Fax Number: | 2156382119 |
| Mailing Address: | 2612 Linconia Ave, TREVOSE |
| State: | PA |
| Postal Code: | 190536736 |
| Phone Number: | 2679807415 |
| Fax Number: | 2156382119 |
| NPI Enumeration Date: | 04/08/2016 |
| NPI Last Update Date: | 04/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | 45AB00000400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |