Petro Matsyshyn, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02484400 Issued in NJ

Practice address

330 Main St
Hartford, CT 06106-1860

Phone

(860) 899-2804

NPI assigned

Jul 5, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341964800000",
    "number": "1508153099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 TOWNE ST",
            "address_2": "APT. 464",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069025952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061860",
            "telephone_number": "860-899-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSYSHYN",
        "first_name": "PETRO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-05",
        "last_updated": "2012-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02484400",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deepali Mathur
• James John Matino, MD
• Kelly S Matmati, M.D.
• Adam Matson, MD
• Lois E. Matson, RD
• Mary Mattaliano, RN
• Alexandra Jean Matthews, DCN, RD, CDN
• Andria Danielle Matthews
• Amelia May Maurer, PA-C
• Shelley Robyn May

• Dentist in Hartford, CT
• Providers in Hartford, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.