Kenneth F Mattucci, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

096685 Issued in NY

Practice address

29 Barstow Rd
Suite 203
Great Neck, NY 11021-2209

Phone

(516) 482-7960

Fax

(516) 482-4122

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 12, 2023 through Sep 12, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore Otolaryngology Assoc, P.C.

  • Specialist
  • Manhasset, NY
  • NPI 1134175482
  NPD (past)
• Ronald a Levy MD PC

  • Specialist
  • Great Neck, NY
  • NPI 1164727137
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1013957059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 NOME DR",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117973404",
            "telephone_number": "516-367-4281",
            "fax_number": "516-367-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BARSTOW RD",
            "address_2": "SUITE 203",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110212209",
            "telephone_number": "516-482-7960",
            "fax_number": "516-482-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTUCCI",
        "first_name": "KENNETH",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "096685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Mathew
• Sharlene Mathew, AGACNP
• Iby Mathews, MS, OTR/L
• Mara Elizabeth Matkovic, M.D.
• Kelly O'Malley Mattone, M.D.
• Thomas Michael Mauri, M.D.
• Kenneth Mauro, P.T.
• Kristie Mauro, DPT
• Zenobia Mauro
• Maya'S Clinic LLC

• Specialist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.