Active NPI
Matthew J O'Connor Sr., R.N.
- Chore Provider
- Medford, NY
National Provider Identifier
1699038919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chore Provider
- License
- 408736
- Practice address
- 404 Birchwood Rd
Medford, NY 11763-1232 - Phone
- (631) 566-1147
- NPI assigned
- Jun 21, 2012
- 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 |
|---|---|---|---|---|
| Chore Provider | 372500000X | 408736 | NY | Primary |
Addresses
Primary practice location
404 Birchwood Rd
Medford, NY 11763-1232
Mailing address
404 Birchwood Rd
Medford, NY 11763-1232
Phone (631) 566-1147
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 Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 408736 | NY | MD | Chore Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1699038919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 BIRCHWOOD RD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631232",
"telephone_number": "631-566-1147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 BIRCHWOOD RD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631232",
"telephone_number": "631-566-1147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'CONNOR",
"first_name": "MATTHEW",
"middle_name": "J",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-21",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "372500000X",
"taxonomy_group": "",
"desc": "Chore Provider",
"state": "NY",
"license": "408736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.