Active NPI
Paul Louis Mattiola, RPH
- Pharmacist
- Staten Island, NY
National Provider Identifier
1205938990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 023988
- Practice address
- 500 Tompkins Ave
Staten Island, NY 10305-1743 - Phone
- (718) 727-0426
- Fax
- (718) 816-1803
- NPI assigned
- Sep 2, 2006
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 023988 | NY | Primary |
Addresses
Primary practice location
500 Tompkins Ave
Staten Island, NY 10305-1743
Mailing address
500 Tompkins Ave
Staten Island, NY 10305-1743
Phone (718) 727-0426
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12030 | Other | NY | NYS LICENSE NUMBER |
| 00259687 | Medicaid | NY | |
| 3304312 | Other | NY | NCPDP NUMBER |
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 |
|---|---|---|---|
| 023988 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rosebank Pharmacy LLC | Past | Accepting new patients | |
| Rosebank Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Long Term Care Pharmacy
- Staten Island, NY
- NPI 1073324604
-
- Community/Retail Pharmacy
- Staten Island, NY
- NPI 1205914710
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1205938990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 TOMPKINS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103051743",
"telephone_number": "718-727-0426",
"fax_number": "718-816-1803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 TOMPKINS AVE",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103051743",
"telephone_number": "718-727-0426",
"fax_number": "718-816-1803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTIOLA",
"first_name": "PAUL",
"middle_name": "LOUIS",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "023988",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS LICENSE NUMBER",
"identifier": "12030",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00259687",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP NUMBER",
"identifier": "3304312",
"state": "NY"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.