Active NPI
John A Mattera, RPH
- Pharmacist
- Staten Island, NY
National Provider Identifier
1023301678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30921
- Practice address
- 121 McClean Ave
Staten Island, NY 10305-4655 - Phone
- (718) 447-3117
- NPI assigned
- May 16, 2011
- Last updated
- May 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 30921 | NY | Primary |
Addresses
Primary practice location
121 McClean Ave
Staten Island, NY 10305-4655
Mailing address
62 Ocean Ave
Staten Island, NY 10305-4710
Phone (718) 720-6774
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30921 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arrochar Pharmacy Inc | Pharmacist | Current | Accepting new patients |
Locations
121 McClean Ave
Staten Island, NY 10305
Phone (718) 447-3117
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305504000000",
"number": "1023301678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 OCEAN AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103054710",
"telephone_number": "718-720-6774",
"fax_number": "718-447-8918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 MCCLEAN AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103054655",
"telephone_number": "718-447-3117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTERA",
"first_name": "JOHN",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-16",
"last_updated": "2011-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "30921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.