Active NPI
John V. Matera, RPH
- Pharmacist
- Long Island City, NY
National Provider Identifier
1962652578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 031829
- Practice address
- 3711 Queens Blvd
Long Island City, NY 11101-1725 - Phone
- (718) 361-5100
- Fax
- (718) 262-9744
- NPI assigned
- Sep 19, 2008
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 031829 | NY | Primary |
Addresses
Primary practice location
3711 Queens Blvd
Long Island City, NY 11101-1725
Mailing address
170-05 Linden Blvd.
St. Albans, NY 11433
Phone (718) 262-9661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 031829 | Medicaid | NY |
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 Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031829 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551312000000",
"number": "1962652578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170-05 LINDEN BLVD.",
"city": "ST. ALBANS",
"state": "NY",
"postal_code": "11433",
"telephone_number": "718-262-9661",
"fax_number": "718-262-9744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3711 QUEENS BLVD",
"city": "LONG ISLAND CITY",
"state": "NY",
"postal_code": "111011725",
"telephone_number": "718-361-5100",
"fax_number": "718-262-9744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATERA",
"first_name": "JOHN",
"middle_name": "V.",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-19",
"last_updated": "2019-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "031829",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "031829",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Island City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.