Provider Demographics
NPI:1083334973
Name:ROBUSTIANO, MATTIA (RN)
Entity Type:Individual
Prefix:
First Name:MATTIA
Middle Name:
Last Name:ROBUSTIANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2404
Mailing Address - Country:US
Mailing Address - Phone:518-935-5085
Mailing Address - Fax:
Practice Address - Street 1:442 ROUTE 40
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182
Practice Address - Country:US
Practice Address - Phone:518-935-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY794937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse