Provider Demographics
NPI:1033458179
Name:PERNICE, MATTHEW JOHN (FNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:PERNICE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5328
Mailing Address - Country:US
Mailing Address - Phone:631-680-6052
Mailing Address - Fax:
Practice Address - Street 1:696 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6444
Practice Address - Country:US
Practice Address - Phone:845-204-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-09
Last Update Date:2024-01-22
Deactivation Date:2023-12-14
Deactivation Code:
Reactivation Date:2023-12-20
Provider Licenses
StateLicense IDTaxonomies
NY353340363LF0000X
NY660053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse