Provider Demographics
NPI:1972850204
Name:MATERASSO, ANTOINETTE P (MS,RN)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:P
Last Name:MATERASSO
Suffix:
Gender:F
Credentials:MS,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2016
Mailing Address - Country:US
Mailing Address - Phone:914-238-6156
Mailing Address - Fax:914-238-7522
Practice Address - Street 1:530 QUAKER RD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-2016
Practice Address - Country:US
Practice Address - Phone:914-238-6156
Practice Address - Fax:914-238-7522
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351275163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool