Active NPI
Matthew Idelson
- Pharmacist
- Garnet Valley, PA
National Provider Identifier
1225647654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- A1-0005417
- Practice address
- 22 Vernon LN
Garnet Valley, PA 19060-1319 - Phone
- (610) 888-4520
- NPI assigned
- Jul 31, 2020
- Last updated
- Jul 31, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | A1-0005417 | DE | Primary |
| Pharmacist | 183500000X | RP453422 | PA |
Addresses
Primary practice location
22 Vernon LN
Garnet Valley, PA 19060-1319
Mailing address
22 Vernon LN
Garnet Valley, PA 19060-1319
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 |
|---|---|---|---|
| A1-0005417 | DE | MD | Pharmacist |
| RP453422 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596153600000",
"number": "1225647654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 VERNON LN",
"city": "GARNET VALLEY",
"state": "PA",
"postal_code": "190601319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 VERNON LN",
"city": "GARNET VALLEY",
"state": "PA",
"postal_code": "190601319",
"telephone_number": "610-888-4520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDELSON",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-31",
"last_updated": "2020-07-31",
"certification_date": "2020-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "DE",
"license": "A1-0005417",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP453422",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garnet Valley, PA
- Alyssa Ann Gutowiecz, PTA
- Catherine Hammer, MFT
- Stephanie Hashinger, COTA/L
- Yuhong He, PH.D.
- Donna C Hugues, CMT
- Its Mine Movement, Inc
- K & K RX Services, LP (BioMatrix Specialty Pharmacy PA)
- K & K RX Services, LP (BioMatrix Specialty Pharmacy PA)
- K & K RX Services, LP (BioMatrix Specialty Pharmacy PA)
- K & K RX Services, LP (BioMatrix Specialty Pharmacy PA)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.