Sydney Kristine Mattera, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00814100 Issued in NJ

Practice address

63 Grand Ave
River Edge, NJ 07661-1930

Phone

(201) 696-2646

NPI assigned

Oct 6, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1871374736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 PROSPECT AVE",
            "city": "RIDGEFIELD",
            "state": "NJ",
            "postal_code": "076571712",
            "telephone_number": "201-638-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 GRAND AVE",
            "city": "RIVER EDGE",
            "state": "NJ",
            "postal_code": "076611930",
            "telephone_number": "201-696-2646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "627 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "NJ",
            "postal_code": "076571712",
            "country_code": "US",
            "telephone_number": "201-638-1237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTERA",
        "first_name": "SYDNEY",
        "middle_name": "KRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-06",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00814100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Mariano, LPC, LCADC
• Mark S Goldfarb, MD, PA
• Marlen Martirossian, D.D.S.
• Joshua Bryan Masarof
• Julia Masur
• William Frederick Maurice, LPC, LCADC
• Jodi A McLean, MSOTR/L
• Medicalsupplycompany
• Delfin Mendoza
• Anwar Mghari, FNP

• Physician Assistant in River Edge, NJ
• Providers in River Edge, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.