Active NPI
Matthew Moderno, LMT
- Massage Therapist
- Baldwin, NY
National Provider Identifier
1104563063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 028230
- Practice address
- 2789 Milburn Ave
Baldwin, NY 11510-4119 - Phone
- (516) 457-7371
- NPI assigned
- May 12, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 028230 | NY | Primary |
Addresses
Primary practice location
2789 Milburn Ave
Baldwin, NY 11510-4119
Mailing address
PO Box 22
Merrick, NY 11566-0022
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 028230 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1104563063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22",
"city": "MERRICK",
"state": "NY",
"postal_code": "115660022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2789 MILBURN AVE",
"city": "BALDWIN",
"state": "NY",
"postal_code": "115104119",
"telephone_number": "516-457-7371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODERNO",
"first_name": "MATTHEW",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-12",
"last_updated": "2022-05-12",
"certification_date": "2022-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "028230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baldwin, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.