Active NPI
Michele Lynn Matera, ATC, LAT
- Athletic Trainer
- Bay Shore, NY
National Provider Identifier
1972937704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0021391
- Practice address
- 84 E Lakeland St
Bay Shore, NY 11706-2028 - Phone
- (631) 601-4113
- NPI assigned
- Aug 28, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0021391 | NY | Primary |
Addresses
Primary practice location
84 E Lakeland St
Bay Shore, NY 11706-2028
Mailing address
84 E Lakeland St
Bay Shore, NY 11706-2028
Phone (631) 601-4113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Other | RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0021391 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1972937704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "84 E LAKELAND ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117062028",
"telephone_number": "631-601-4113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "84 E LAKELAND ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117062028",
"telephone_number": "631-601-4113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATERA",
"first_name": "MICHELE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-28",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "0021391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS",
"identifier": "22",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.