NPIMap

Organization Active NPI

Matthew Colucci P.T.,P.C.

  • Physical Therapist
  • East Islip, NY
National Provider Identifier
1053472209
Registry record updated Dec 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
011517 Issued in NY
Legal business name
MATTHEW COLUCCI P.T.,P.C.
Practice address
15 Dixie LN
East Islip, NY 11730-2518
Phone
(516) 380-8450
Fax
(631) 650-1791
NPI assigned
Dec 12, 2006
Last updated
Dec 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2007

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

Authorized official

Name
Mr. Matthew F. Colucci, P.T.NPI 1932151453
Title
President
Phone
(516) 380-8450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 011517 NY Primary

Addresses

Primary practice location

15 Dixie LN
East Islip, NY 11730-2518

Mailing address

15 Dixie LN
East Islip, NY 11730-2518
Phone (516) 380-8450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317001483 NY Part B Supplier - Clinic/Group Practice 9133019771 Receives reassigned benefits from 5 practitioners
Practice locations: East Islip, NY; Hauppauge, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197504000000",
    "number": "1053472209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 DIXIE LN",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302518",
            "telephone_number": "516-380-8450",
            "fax_number": "631-650-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DIXIE LN",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302518",
            "telephone_number": "516-380-8450",
            "fax_number": "631-650-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW COLUCCI P.T.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-12-13",
        "status": "A",
        "authorized_official_last_name": "COLUCCI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-380-8450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "011517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.