NPIMap

Individual provider Active NPI

Matthew Banaszak

  • Specialist
  • Garden City, NY
National Provider Identifier
1306275078
Registry record updated Nov 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
772087166 Issued in NY
Practice address
300 Garden City PLZ
Garden City, NY 11530-3302
Phone
(516) 747-9030
NPI assigned
Nov 4, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 772087166 NY Primary

Addresses

Primary practice location

300 Garden City PLZ
Garden City, NY 11530-3302

Mailing address

1 Fenimore Rd
Bayport, NY 11705-2115
Phone (631) 707-3797

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gayle E Kilgman Therapuetic Resources Past Accepting new patients
Kidz Therapy Services, 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.

NPI Registry JSON

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383523200000",
    "number": "1306275078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FENIMORE RD",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117052115",
            "telephone_number": "631-707-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GARDEN CITY PLZ",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115303302",
            "telephone_number": "516-747-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANASZAK",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "772087166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.