Provider Demographics
NPI:1336550359
Name:MATTEI, ELISA M (FMHNP)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:M
Last Name:MATTEI
Suffix:
Gender:F
Credentials:FMHNP
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Mailing Address - Street 1:455 TARRY TOWN ROAD SUITE 1594
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607
Mailing Address - Country:US
Mailing Address - Phone:914-490-6199
Mailing Address - Fax:888-852-8738
Practice Address - Street 1:5550 MERRICK RD STE 200
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6238
Practice Address - Country:US
Practice Address - Phone:914-490-6199
Practice Address - Fax:888-852-8738
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY677457163W00000X
NYF403765-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY677457Medicaid