Provider Demographics
NPI:1447038641
Name:MATTEO, GEORGE EDWARD
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:MATTEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CALHOUN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-1525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 BULLS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH KENT
Practice Address - State:CT
Practice Address - Zip Code:06785-1118
Practice Address - Country:US
Practice Address - Phone:860-990-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer