Provider Demographics
NPI:1508598160
Name:MATTUCCI, JOSHUA J
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:MATTUCCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 WESTINGHOUSE RD STE 532
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8118
Mailing Address - Country:US
Mailing Address - Phone:607-442-9070
Mailing Address - Fax:607-735-2228
Practice Address - Street 1:2898 WESTINGHOUSE RD STE 532
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8118
Practice Address - Country:US
Practice Address - Phone:607-442-9070
Practice Address - Fax:607-735-2228
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009025156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician